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Left atrium volume predicts mortality among patients with PE

Decreased volume in the left atrium appeared associated with greater mortality risk among patients with pulmonary embolism, according to results of a retrospective study.

Prior research suggested an association between small left atrium and severe acute pulmonary embolism.

In the current study, Galit Aviram, MD, of the department of radiology at Tel Aviv Sourasky Medical Center in Tel Aviv, Israel, and colleagues retrospectively analyzed 756 patients who underwent computerized tomographic pulmonary angiography between 2007 and 2010 and received an acute PE diagnosis.

The researchers used volumetric analysis software to determine the volumes of the left atrium, right atrium, right ventricle and left ventricle.

They used a classification tree to divide the cardiac chamber volumes and ratios into categories based on mortality. Researchers also used Cox regression analysis to evaluate associations between these categories and 30-day mortality, taking into account age, sex and clinical background.

The final analysis included 636 patients for whom complete outcome data were available. All patients had successful volumetric segmentation.

Researchers reported an overall 13.2% mortality rate (n = 84) within 30 days of PE diagnosis.

Patients who had a left atrium volume of 62 mL or less demonstrated a significantly higher mortality rate than those with a left atrium volume greater than 62 mL (19.2% vs. 8.9%; HR = 2.44; 95% CI, 1.52-3.9).

Patients who had a left atrium volume of 67 mL or less demonstrated a significantly higher mortality rate than those with a left atrium volume greater than 67 mL (16.4% vs. 8.3; HR = 1.8; 95% CI, 1.08-3.01).

Patients with a right atrium/left atrium volume ratio greater than 1.2 demonstrated a higher mortality risk than those with a ratio of 1.2 or less (17% vs. 9.4%; HR = 2.1; 95% CI, 1.32-3.37).

“We employed a new tool based on volumetric analysis of all four cardiac chambers obtained from routine non-gated computerized tomographic pulmonary angiography performed for PE diagnosis,” Aviram and colleagues wrote. “We were able to show that a decreased left atrium volume is associated with a higher ≤30-day mortality, and that it is the strongest predictor of mortality in patients with acute PE.

“Accordingly, the presence of [a left atrium] volume ≤62 mL during the diagnosis of PE by computerized tomographic pulmonary angiography may serve as a potential early radiophysiological sign of an adverse prognosis,” they added. “Application of an automatic volumetric assessment may allow improvement of care in patients with acute PE by expedition of risk assessment. Large-scale prospective studies are required for further evaluation of the possible advantages of the new approach.”

Disclosure: Aviram reports a research grant to his institution from Philips Medical Systems.