Prognostic Value Of Left Atrial Volume Index In Patients With Mild To Moderate Chronic Heart Failure And Effect Of Carvedilol On Left Atrial Volume Index And Prognosis

Background:Chronic heart failure (CHF) is the end-stage of variety serious heart disease. In spite of the therapeutic method had most progresses over the last ten years, total prognosis was still poor, deaths total rate, incidence rate of cardiovascular event and readmission rate were very high. Early evaluation and treatment improve prognosis in CHF patients obviously, so it is very important to evaluate and treat exactly in mild and moderate CHF patients. Oversea scholars confirmed left atrial volume index (LAVi) represents left ventricular full pressure, is closely associated with left ventricle diastolic function, should be considered an integrated index with the ability to summarize global systolic and diastolic modifications of the left ventricle throughout the entire duration of the disease. It should be acknowledged that the left atrium may dilate for reasons other than diastolic dysfunction, such as left ventricular remodelling, neurohormone, mitral regurgitation and atrial fibrillation. these pathophysiological variables are all associated with poor prognosis.βacceptor blockers have become standard therapy for patients with CHF. It is widely confirmed that carvelilol can improve left ventricular remonelling, regulate neurohormone, elevate left ventricular functions. The research intend to evaluate prognostic value of LAVi in Chongqing patients with mild to moderate CHF and effect of carvedilol on LAVi and prognosis, evaluate ability of LAVi as prognostic index.Objective:1. To analyze the prognostic impact of LAVi in patients with mild to moderate CHF.2. To investigate the effect of carvedilol on LAVi and prognosis in patients with mild to moderate heart failure. Methods:1. Selective, exclusive criteria and drug intervention:①Selective and exclusive criteria: One hundred and ten CHF patients with NYHA classesⅡorⅢaccording with Framingham were enrolled. Patients with unstable angina, acute myocardial infarction, severe valvular heart disease and coronary artery revascularization or acute cerebral accident history in 2 months were excluded.②Drug intervention: 53 patients withoutβacceptor blocker contraindication were randomized to carvedilol group(n=25) and control group(n=28). Besides conventional therapy for CHF(diuretic and ACEI) carvedilol group also accepted carvedilol treatment which started from low dose to maximum tolerated dose or target dose. Control group only accepted diuretic and ACEI as CHF therapy.2. Detection indices: body height, age, cardiac functional grading, systolic pressure, diastolic pressure, LAVi, left ventricular ejection fraction(LVEF), E/A , mitral reflux, sodium ion concentration, kalium ion concentration, creatinine, rest cardiac output(CO), 6 minute walk test(6MWT) and exercise cardiac output was detected at the beginning of enrolment. LAVi levels were detected at the third month and sixth month in carvedilol group and control group.3. Follow-up information was obtained from clinical records, telephone correspondence. The end point was cardiac death, pump failure, hospitalisation for worsening heart failure. In the event of death, the underlying cause was obtained from the hospital record or interviews with the referral doctor or relatives.Results:1.Logistic regression analysis showed that an increased hazard of death and /or rehospitalization had variables association with LAVi. LAVi was strongly associated with adverse outcome, with a 4.8% increase in risk for every 1 ml/m~2 of LAVi (95% confidence interval 1.001 to 1.096, P < 0.05). Area under the curve for LAVi in evaluating prognosis of CHF patients was 0.851 (sensitivity 85.5%, specificity 75.6% ) .2. (1)The levels of LAVi at 3 month and 6 month in carvedilol group are 37±9.8 ml/m~2 and 33±13.7 ml/m~2 respectively, significantly lower than before crvedilol treatment 42±11.7ml/m~2(P<0.05), the level of LAVi at 6 month significantly lower than concurrent control group (P<0.05);(2) Over a mean follow-up period of 12±4 months, the end point was reached by 3 patients in carvedilol group and 7 patients in control group. The prognosis in carvedilol group was better than control group (P<0.05).Conclusion:1. LAVi level on admission is a strong predictor of prognosis in patients with mild to moderate CHF after adjustment for clinical factors, 6MWT, LVEF, exercise cardiac output increment.2. Our findings reveal that carvedilol added to conventional treatment in patients with mild to moderate heart failure for six month caused a decrease in LAVi and improved prognosis.