Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study

Research output: Contribution to journalArticle

Mohammad A. Khan, Eric Y. Yang, Yang Zhan, Robert M. Judd, Wenyaw Chan, Faisal Nabi, John F. Heitner, Raymond J. Kim, Igor Klem, Sherif Nagueh, Dipan J. Shah

Background: Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method: We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21-52 ml/m2), Mild (52-62 ml/m2), Moderate (63-73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results: The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1-71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death. Conclusion: LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.

Original languageEnglish (US)
Article number4
Pages (from-to)4
JournalJournal of Cardiovascular Magnetic Resonance
Volume21
Issue number1
DOIs
StatePublished - Jan 7 2019

PMID: 30612579

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Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance : a multicenter study. / Khan, Mohammad A.; Yang, Eric Y.; Zhan, Yang; Judd, Robert M.; Chan, Wenyaw; Nabi, Faisal; Heitner, John F.; Kim, Raymond J.; Klem, Igor; Nagueh, Sherif; Shah, Dipan J.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 21, No. 1, 4, 07.01.2019, p. 4.

Research output: Contribution to journalArticle

Harvard

Khan, MA, Yang, EY, Zhan, Y, Judd, RM, Chan, W, Nabi, F, Heitner, JF, Kim, RJ, Klem, I, Nagueh, S & Shah, DJ 2019, 'Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study' Journal of Cardiovascular Magnetic Resonance, vol. 21, no. 1, 4, pp. 4. https://doi.org/10.1186/s12968-018-0517-0

APA

Khan, M. A., Yang, E. Y., Zhan, Y., Judd, R. M., Chan, W., Nabi, F., ... Shah, D. J. (2019). Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study. Journal of Cardiovascular Magnetic Resonance, 21(1), 4. [4]. https://doi.org/10.1186/s12968-018-0517-0

Vancouver

Khan MA, Yang EY, Zhan Y, Judd RM, Chan W, Nabi F et al. Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study. Journal of Cardiovascular Magnetic Resonance. 2019 Jan 7;21(1):4. 4. https://doi.org/10.1186/s12968-018-0517-0

Author

Khan, Mohammad A. ; Yang, Eric Y. ; Zhan, Yang ; Judd, Robert M. ; Chan, Wenyaw ; Nabi, Faisal ; Heitner, John F. ; Kim, Raymond J. ; Klem, Igor ; Nagueh, Sherif ; Shah, Dipan J. / Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance : a multicenter study. In: Journal of Cardiovascular Magnetic Resonance. 2019 ; Vol. 21, No. 1. pp. 4.

BibTeX

@article{4296e63160d24840a4b61eea46ca2cf7,
title = "Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study",
abstract = "Background: Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method: We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21-52 ml/m2), Mild (52-62 ml/m2), Moderate (63-73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results: The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1-71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95{\%} Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95{\%} CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95{\%} CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95{\%} CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95{\%} CI 1.29 to 2.08)] remained independent predictors of death. Conclusion: LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.",
keywords = "Biplane area-length method, Cardiac magnetic resonance, Left atrial volume, Mortality",
author = "Khan, {Mohammad A.} and Yang, {Eric Y.} and Yang Zhan and Judd, {Robert M.} and Wenyaw Chan and Faisal Nabi and Heitner, {John F.} and Kim, {Raymond J.} and Igor Klem and Sherif Nagueh and Shah, {Dipan J.}",
year = "2019",
month = "1",
day = "7",
doi = "10.1186/s12968-018-0517-0",
language = "English (US)",
volume = "21",
pages = "4",
journal = "Journal of Cardiovascular Magnetic Resonance",
issn = "1097-6647",
publisher = "BioMed Central",
number = "1",

}

RIS

TY - JOUR

T1 - Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance

T2 - Journal of Cardiovascular Magnetic Resonance

AU - Khan, Mohammad A.

AU - Yang, Eric Y.

AU - Zhan, Yang

AU - Judd, Robert M.

AU - Chan, Wenyaw

AU - Nabi, Faisal

AU - Heitner, John F.

AU - Kim, Raymond J.

AU - Klem, Igor

AU - Nagueh, Sherif

AU - Shah, Dipan J.

PY - 2019/1/7

Y1 - 2019/1/7

N2 - Background: Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method: We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21-52 ml/m2), Mild (52-62 ml/m2), Moderate (63-73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results: The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1-71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death. Conclusion: LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.

AB - Background: Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method: We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21-52 ml/m2), Mild (52-62 ml/m2), Moderate (63-73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results: The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1-71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death. Conclusion: LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.

KW - Biplane area-length method

KW - Cardiac magnetic resonance

KW - Left atrial volume

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85059500806&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059500806&partnerID=8YFLogxK

U2 - 10.1186/s12968-018-0517-0

DO - 10.1186/s12968-018-0517-0

M3 - Article

VL - 21

SP - 4

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

SN - 1097-6647

IS - 1

M1 - 4

ER -

ID: 44455790