Left atrial volume index is useful for predicting increased pulmonary artery wedge pressure in coronary heart disease patients with mildly elevated E/E'

Background: The ratio of early transmitral velocity to early diastolic velocity of the mitral annulus(E/E')has been shown to be an excellent predictor of left ventricular filling pressure. However, the clinical significance of mildly elevated E/E' (8≤ E/E' ≤ 15)remains to be clarified. Left atrial(LA)volume would reflect the duration and severity of left ventricular diastolic dysfunction. There is a graded relation between LA volume index(LAVI)and severity of diastolic dysfunction. Purpose: We hypothesized that LAVI could be useful for predicting increased PAWP in coronary heart disease patients with mildly elevated E/E'. Subjects and Methods: Patients admitted to the coronary care unit at our hospital who had indwelling pulmonary artery catheters were eligible. Fifty-eight patients without atrial fibrillation or severe mitral regurgitation underwent echocardiography(Sonos 5500 or 7500; S3 probe; Philips). Tissue Doppler imaging of the mitral annulus was also obtained. Early diastolic E' velocity was measured from the septal mitral annulus velocity profile in the apical 4-chamber view. LA volume was assessed by the biplane Simpson's method from apical 4- and 2-chamber views in end systole. LAVI was obtained by correcting for body surface area. PAWP was measured simultaneously in all the patients. Results: In 23 patients with mildly elevated E/E' (8≤ E/E' ≤ 15), there was no correlation between PAWP and E/E' (p=0. 40). However, LAVI positively correlated with PAWP in those patients(r=0. 64, p <; 0. 001). LAVI ≤ 32 ml/m² was the optimal cutoff to predict PAWP≤ 15 mmHg(sensitivity 72 %, specificity 80 %). Conclusion: LAVI could be a useful adjunct measure for predicting increased PAWP in coronary heart disease patients with mildly elevated E/E'.