- 作者：Victor Chien-Chia Wu ; Masaaki Takeuchi ; Hiroshi Kuwaki ; Mai Iwataki ; Yasufumi Nagata ; Kyoko Otani ; Nobuhiko Haruki ; Hidetoshi Yoshitani ; Masahito Tamura ; Haruhiko Abe ; Kazuaki Negishi ; Fen-Chiung Lin ; Yutaka Otsuji
- 关键词：3D echocardiography ; left atrium ; prognosis
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：6
- 期：10
- 页码：1025-1035
- 全文大小：459 K
Objectives
The hypothesis of this study was that minimal left atrial volume index (LAVImin) by 3-dimensional echocardiography (3DE) is the best predictor of future cardiovascular events.Background
Although maximal left atrial volume index (LAVImax) by 2-dimensional echocardiography (2DE) is a robust index for predicting prognosis, the prognostic value of LAVImin and the superiority of measurements by 3DE over 2DE have not been determined in a large group of patients.
Methods
In protocol 1, we assessed age and sex dependency of LAVIs using 2DE and 3DE in 124 normal subjects and determined their cutoff values (mean?+ 2 SD). In protocol 2, 2-dimensional (2D) and 3-dimensional (3D) LAVImax/LAVImin were measured in 556 patients with high prevalence of cardiovascular disease. After excluding patients with atrial fibrillation, mitral valve disease, and age <18 years, 439 subjects were followed to record major adverse cardiovascular events (MACE). Patients were divided into 2 groups by the cutoff criteria of LAVI in each method.
Results
In protocol 1, there was no significant age and sex dependency for each 2D and 3D LAVI. In protocol 2, during a mean of 2.5 years of follow-up, MACE developed in 88 patients, including 32 cardiac deaths. Kaplan-Meier survival analyses showed that all 4 LAVI cutoff criteria had significant predictive power of MACE. After variables were adjusted for clinical variables and left ventricular ejection fraction, all 4 methods were still independently and significantly associated with MACE, but 3D-derived LAVImin had the highest risk ratio. 3D LAVImin also had an incremental prognostic value over 3D LAVImax.
Conclusions
LAVIs by both 2DE and 3DE are powerful predictors of future cardiac events. 3D LAVImin tended to have a stronger and additive prognostic value than 3D LAVImax.