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Right atrial volume index to left atrial volume index ratio is associated with adverse clinical outcomes in cardiogenic shock



Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS.


Patients in this cohort were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure > 15) and cardiogenic shock (cardiac index < 2.2, systolic blood pressure < 90 mmHg, and clinical evidence supporting CS) and had an echocardiogram at the time of admission. RAVI was measured using Simpson’s method in the apical four-chamber view, while LAVI was measured using the biplane disc summation method in the four and two-chamber views by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD).


Among 113 patients (mean age 59 ± 14.9 years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12 months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD. Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p ≤ 0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11–2.64, chi square 5.91, p = 0.010) even after adjustment for patient characteristics, echocardiographic and hemodynamic variables.


RAVI/LAVI is an easily assessed novel echocardiographic parameter strongly associated with the survival and or the need for mechanical circulatory support in patients with CS.

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Dr. Breathett has research funding from National Heart, Lung, and Blood Institute (NHLBI) K01HL142848, R25HL126146 subaward 11692sc, and L30HL148881; University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant; and University of Arizona, Sarver Heart Center, Novel Research Project Award in the Area of Cardiovascular Disease and Medicine, Anthony and Mary Zoia Research Award. Dr. Bilchick’s work on this project was supported by grants R56 HL135556 and R21HL140445 from the NHLBI. He also has research support from Medtronic and Siemens Healthineers. Nishaki Mehta has received a speaker honorarium from Abbot/Medtronic.

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Correspondence to Paras R. Patel.

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Paras Patel, Patrick L. Stafford, McCall R. Walker, Sami Ibrahim, David Martin, Yaqub Betz, Toral Patel, Younghoon Kwon, Nishtha Sodhi, Hunter Mwansa, Khadijah Breathett, and Sula Mazimba declare that they have no conflict of interest.

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Patel, P.R., Stafford, P.L., Bilchick, K.C. et al. Right atrial volume index to left atrial volume index ratio is associated with adverse clinical outcomes in cardiogenic shock. J Echocardiogr (2021).

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  • Cardiogenic shock
  • Chronic systolic heart failure
  • Right atrial volume index
  • Outcomes