Atrial Volume Predicts Cardiovascular Events

Left atrial volume (LAV) measurement is a promising and powerful tool for the evaluation and monitoring of patients with atrial fibrillation (AF), a new study suggests.

In this study, scientists at the Mayo Clinic (Rochester, MN, USA) conducted a long-range (median of 27 years) follow-up of 46 patients with lone AF. Twenty-three of the patients (50%) experienced cardiovascular events. Cerebral infarction occurred in seven patients, myocardial infarction occurred in 11, and congestive heart failure in 16.

In an attempt to find out why a benign lone AF may evolve into a risk-associated AF, the Mayo group measured the changes in LAV. Patients with ‘uncomplicated' lone AF had normal atrial size, which remained unchanged for decades, signifying very low risk. Only when the atria became large, signifying increased atrial pressure, did stroke and heart failure begin to occur.

In a multivariate analysis, patients with an LAV index of 32 ml/m2 or greater had a significantly worse event-free survival. All the cerebral infarctions occurred in these patients. The results were published in the December 2005 edition of the European Heart Journal.

"Only atrial size, and not the duration and type of AF, were related to stroke and other risks,” said Dr. James B. Seward, an author of the study. "Physiological heart failure as depicted by atrial enlargement was the cause of AF-associated stroke and other risks.



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