The additional prognostic value of left atrial volume on the outcome of patients after surgical ventricular reconstruction

Background: Left atrial volume (LAV) is a powerful predictor of outcome in patients with chronic heart failure (HF). It is unknown whether LAV provides additional prognostic information in patients undergoing surgical ventricular reconstruction (SVR). Our objective was to assess the prognostic power of LAV on survival in patients with HF after undergoing SVR. Methods: One hundred twenty-eight patients (109 men aged 64 ± 9 years) referred to our center for surgical ventricular reconstruction had an echocardiographic assessment of LAV at admission. Results: Overall, 18 patients experienced operative mortality. The median follow-up time for the 110 survivors was 32 months. At Cox regression analysis, left atrial volume index (LAVI) (LAV/body surface area - mL/m²) was inversely associated with survival rate (hazard ratio [HR], 1.033 for every 1 mL/m² of LAVI; 95% confidence interval [CI], 1.015-1.051; p = 0.001). The predictive value of LAVI was independent of age and the more powerful preoperative diastolic restrictive pattern (RP) (HR, 1.56; 95% CI, 1.06-2.31; p = 0.024 for LAVI quartile; HR, 1.09; 95% CI, 1.05-1.14; p = 0.001 for age; and HR, 7.31; 95% CI, 3.1-17.4; p = 0.001 for diastolic RP). A receiver operating characteristic (ROC) curve analysis for separate models was applied to determine the discriminatory power of each determinant of survival. The best accuracy was achieved by including the LAVI quartile, which increased the accuracy of survival prediction up to 0.87 (95% CI, 0.81-0.93). Conclusions: Preoperative LAV is a powerful indicator of poor outcome after SVR and improves the accuracy of survival prediction when added to other independent determinants.