Prognostic value of left atrial volume index in patients with rheumatic mitral stenosis

Background: The significance of left atrial volume index (LAVI) for predicting outcomes in patients with mitral stenosis (MS) has been unclear, even though rheumatic MS is known to be associated with left atrium enlargement and functional deterioration. Hypothesis: The current study aimed to investigate the prognostic value of LAVI, based on the severity in patients with rheumatic MS. Methods: We retrospectively reviewed 611 patients with pure rheumatic MS. The prognostic value of LAVI and the effect of MS severity on the prognostic value of LAVI for events were evaluated. The events were defined as a composite end-point that included all-cause death, heart failure admission, mitral valve replacement, percutaneous mitral valvuloplasty, and stroke. Results: There were 236 (38.6%) overall events during a median follow-up of 8 months. The optimal LAVI cutoff for the prognostic threshold was 57 ml/m². The MS severity had a significant effect on the prognostic value of LAVI. A LAVI >57 ml/m² was a prognostic value for events in progressive MS (hazard ratio [HR]: 2.40, 95% confidence interval [CI]: 1.41–5.40, p =.004) and in patients with severe MS (HR: 1.70, 95% CI: 1.06–2.74, p =.029), but it was not prognostic in patients with very severe MS (HR: 1.02, 95% CI: 0.56–1.84, p =.955). Conclusions: The prognostic value of LAVI varies and is dependent on the MS severity. A LAVI >57 mL/m² was independently associated with poor outcomes in patients with progressive MS, while this association was minimized in patients with severe MS.