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Clinical implication of LAVI over A′ ratio in patients with acute coronary syndrome
  1. Hideaki Matsuura1,
  2. Akira Yamada2,
  3. Kunihiko Sugimoto1,
  4. Keiko Sugimoto3,
  5. Masatsugu Iwase2,
  6. Takashi Ishikawa1,
  7. Junichi Ishii1,
  8. Yukio Ozaki2
  1. 1 Clinical Laboratory, Fujita Health University Hospital, Toyoake, Japan
  2. 2 Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
  3. 3 Department of Clinical Physiology, Fujita Health University School of Health Sciences, Toyoake, Japan
  1. Correspondence to Dr Akira Yamada, Fujita Health University Hospital, Toyoake 4701192, Japan; a-yamada{at}


Purpose The ratio of the left atrial volume index (LAVI) and late diastolic mitral annular velocity (A′) is a useful echocardiographic index for identifying advanced left ventricular (LV) diastolic dysfunction in patients with dyspnoea. We investigated the clinical implications and prognostic value of the aforementioned ratio (LAVI/A′) in patients with ST elevation (STE) or non-STE (NSTE) acute coronary syndrome (ACS).

Methods We studied 212 patients with ACS. All patients underwent electrocardiography, echocardiography and measurement of plasma B-type natriuretic peptide (BNP) level on admission. The study endpoints were hospitalisation and mortality because of heart failure (HF).

Results There was a significant, moderate positive correlation between LAVI/A′ and natural logarithm (Ln) BNP level among the participants (r=0.48, p<0.0001). During a mean follow-up of 17 months, eight patients died and nine patients were hospitalised because of HF. The receiver operating characteristics curve indicated that LAVI/A′≥3.0 predicted these events (log-rank, p=0.0021). A significant and moderate positive correlation existed between LAVI/A′ and Ln BNP level in the NSTE-ACS group (n=128; r=0.58, p<0.0001). However, the correlation between LAVI/A′ and Ln BNP level was weaker in the STE-ACS group (n=84; r=0.33, p=0.0017).

Conclusion LAVI/A′ was related to plasma BNP levels in patients with ACS, particularly in those with NSTE-ACS. This index was useful for predicting cardiac events in patients with ACS.

  • cardiac function
  • diastolic dysfunction
  • coronary artery disease
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  • Contributors HM and AY designed the study, analysed and interpreted the data and wrote the manuscript; KuS and KeS performed the experiments and collected the data. MI, TI, JI and YO reviewed and provided critical input for the manuscript. All authors contributed to writing the manuscript and gave final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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