Incremental Prognostic Value of Right and Left Atrial Volume Indices for Predicting Cardiovascular Outcomes in Atrial Fibrillation: A Cohort Study

Abstract

<p>BACKGROUND Atrial fibrillation (AF) is a common arrhythmia associated with high morbidity and mortality. While the left atrial volume index (LAVI) is a known prognostic marker, the right atrial volume index (RAVI) in this setting remains less well defined. This study aimed to investigate the incremental prognostic value of the RAVI alongside the LAVI in predicting adverse cardiovascular outcomes in patients with AF, a common arrhythmia associated with increased morbidity and mortality. MATERIAL AND METHODS A retrospective cohort study was conducted involving 421 patients with non-valvular AF. Patients were classified based on the occurrence of adverse events, including hospitalization for heart failure, stroke, and all-cause mortality. Echocardiographic assessments of LAVI and RAVI were performed according to international guidelines. RESULTS Among the 421 patients, 180 (43%) experienced adverse events. Enlargement of both LAVI and RAVI was significantly associated with death, stroke, and heart failure (P<0.001). In multivariate analysis adjusted for age and sex, LAVI and RAVI were independent predictors of adverse outcomes. The presence of either LAVI or RAVI enlargement was associated with increased mortality (HR=1.96, 95% CI: 1.17-3.31), while the combined enlargement of both indices further increased the risk (HR=4.38, 95% CI: 2.71-7.08). Similar patterns were observed for stroke and heart failure, where the combination of both enlarged indices significantly amplified risk. CONCLUSIONS RAVI adds significant incremental prognostic value to LAVI in patients with AF. Combined assessment of both atrial volume indices enhances risk stratification for heart failure, stroke, and mortality, supporting more personalized treatment approaches in clinical practice.<br></p>