Left Atrial Volumetric/Mechanical Coupling Index

Background: Left atrial assessment is complex, particularly in heart failure with reduced ejection fraction due to interactions functional mitral regurgitation (FMR). Pilot data suggest that left volumetric/mechanical coupling index (LACI) may be useful, but large outcome are lacking. Methods: We enrolled a comprehensively characterized cohort of patients sinus rhythm diagnosis at Mayo Clinic from 2007 2011. Routinely measured volume and tissue-doppler-imaging a’ allowed LACI calculation as (left index)/(tissue-doppler-imaging a’). Survival was the measured. Results: The cohort’s 4196 (69 [58–77] years, 40 [31–45]%) had mild FMR 1505 moderate-severe 1068. overall 5.06 (3.50–8.10) increased each grade (3.86 [2.94–5.29] without FMR, 5.38 [3.80–8.02] mild, 5.45 [1.49–8.07] moderate/severe FMR; P <0.0001). At diagnosis, higher independently determined by more severe ventricular mass index, lower fraction, E/e’, glomerular filtration rate (all During follow-up 1588 (38%) died. In spline modeling, excess mortality appeared around LACI=6 steeply thereafter (5-year survival 72±1% LACI<6 49±2% ≥6, Multivariable comprehensive adjustment showed strong association (adjusted hazard ratio, 1.41 [1.23–1.61], <0.0001 for ≥6). Independent link persistent across grades 1.45 [1.13–1.86], =0.004 1.42 [1.16–1.77], =0.0008 1.38 [1.01–1.66], =0.04 FMR) interaction ( =0.3). independent impact on incremental a’, or any other characteristic including Meta-Analysis Global Group Chronic-score (least significant =0.02). Conclusions: this cohort, routine practice integrates influence several morphological/hemodynamic determinants displays progressive deterioration increasing severity fraction. About outcome, strongly, independently, incrementally associated mortality, irrespective all subsets. Hence, novel critical measure quantifiable practice, which should integrated prognostication decision-making.