TY - JOUR
T1 - Right atrial volume by cardiovascular magnetic resonance predicts mortality in patients with heart failure with reduced ejection fraction
AU - Ivanov, Alexander
AU - Mohamed, Ambreen
AU - Asfour, Ahmed
AU - Ho, Jean
AU - Khan, Saadat A.
AU - Chen, Onn
AU - Klem, Igor
AU - Ramasubbu, Kumudha
AU - Brener, Sorin J.
AU - Heitner, John F.
N1 - Publisher Copyright:
© 2017 Ivanov et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2017/3
Y1 - 2017/3
N2 - Background Right Atrial Volume Index (RAVI) measured by echocardiography is an independent predictor of morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). The aim of this study is to evaluate the predictive value of RAVI assessed by cardiac magnetic resonance (CMR) for all-cause mortality in patients with HFrEF and to assess its additive contribution to the validated Meta-Analysis Global Group in Chronic heart failure (MAGGIC) score. Methods and results We identified 243 patients (mean age 60-15; 33%women) with left ventricular ejection fraction (LVEF)-35%measured by CMR. Right atrial volume was calculated based on area in two-and four-chamber views using validated equation, followed by indexing to body surface area. MAGGIC score was calculated using online calculator. During mean period of 2.4 years 33 patients (14%) died. The mean RAVI was 53-26 ml/m2; significantly larger in patients with than without an event (78.7-29 ml/m2 vs. 48-22 ml/m2, p<0.001). RAVI (per ml/m2) was an independent predictor of mortality [HR =1.03 (1.01-1.04), p =0.001]. RAVI has a greater discriminatory ability than LVEF, left atrial volume index and right ventricular ejection fraction (RVEF) (C-statistic 0.8-0.08 vs 0.55-0.1, 0.62-0.11, 0.68-0.11, respectively, all p<0.02). The addition of RAVI to the MAGGIC score significantly improves risk stratification (integrated discrimination improvement 13%, and category-free net reclassification improvement 73%, both p<0.001). Conclusion RAVI by CMR is an independent predictor of mortality in patients with HFrEF. The addition of RAVI to MAGGIC score improves mortality risk stratification.
AB - Background Right Atrial Volume Index (RAVI) measured by echocardiography is an independent predictor of morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). The aim of this study is to evaluate the predictive value of RAVI assessed by cardiac magnetic resonance (CMR) for all-cause mortality in patients with HFrEF and to assess its additive contribution to the validated Meta-Analysis Global Group in Chronic heart failure (MAGGIC) score. Methods and results We identified 243 patients (mean age 60-15; 33%women) with left ventricular ejection fraction (LVEF)-35%measured by CMR. Right atrial volume was calculated based on area in two-and four-chamber views using validated equation, followed by indexing to body surface area. MAGGIC score was calculated using online calculator. During mean period of 2.4 years 33 patients (14%) died. The mean RAVI was 53-26 ml/m2; significantly larger in patients with than without an event (78.7-29 ml/m2 vs. 48-22 ml/m2, p<0.001). RAVI (per ml/m2) was an independent predictor of mortality [HR =1.03 (1.01-1.04), p =0.001]. RAVI has a greater discriminatory ability than LVEF, left atrial volume index and right ventricular ejection fraction (RVEF) (C-statistic 0.8-0.08 vs 0.55-0.1, 0.62-0.11, 0.68-0.11, respectively, all p<0.02). The addition of RAVI to the MAGGIC score significantly improves risk stratification (integrated discrimination improvement 13%, and category-free net reclassification improvement 73%, both p<0.001). Conclusion RAVI by CMR is an independent predictor of mortality in patients with HFrEF. The addition of RAVI to MAGGIC score improves mortality risk stratification.
UR - https://www.scopus.com/pages/publications/85016811331
U2 - 10.1371/journal.pone.0173245
DO - 10.1371/journal.pone.0173245
M3 - Article
C2 - 28369148
AN - SCOPUS:85016811331
SN - 1932-6203
VL - 12
JO - PLoS ONE
JF - PLoS ONE
IS - 4
M1 - e0173245
ER -