Right Atrial Volume Index to Left Atrial Volume Index Ratio is
Associated with Adverse Clinical Outcomes in Cardiogenic Shock
Abstract
Background: Structural remodeling in chronic systolic heart failure (HF)
is associated with neurohormonal and hemodynamic perturbations among HF
patients presenting with cardiogenic shock (CS) and HF. Objectives: To
test the hypothesis was that atrial remodeling marked by an increased
right atrial volume index (RAVI) to left atrial volume index (LAVI)
ratio is associated with adverse clinical outcomes in CS. Methods:
Patients included were admitted to the intensive care unit with evidence
of congestion (pulmonary capillary wedge pressure >15) and
cardiogenic shock (cardiac index <2.2, systolic blood pressure
<90 mmHg, and clinical evidence supporting CS) and had an
admission echocardiogram. LAVI and RAVI were measured using the biplane
disc summation method by two independent observers. Cox proportional
hazards regression analysis was used to assess the association of
RAVI-LAVI with the combined outcome of death or left ventricular assist
device (LVAD). Results: Among 113 patients (mean age 59 ± 14.9 years,
29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of
12 months, 43 patients died, and 65 patients had the combined outcomes
of death or LVAD.Patients with RAVI/LAVI ratio above the median had a
greater incidence of death or LVAD (Log-rank p=<0.001), and
increasing RAVI/LAVI was significantly associated with the outcomes of
death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p=0.010) even
after adjustment for patient characteristics and hemodynamic variables.
Conclusion: RAVI/LAVI is an easily assessed novel echocardiographic
parameter with strong associations with the survival or the need for
mechanical circulatory support in patients with CS.