Acute short term ultrafiltration produces sustained hemodynamic benefits in acutely decompensated heart failure patients

the relationship between left atrial volume index (LAVI) to PkVO2. Methods: In 82 patients with advanced systolic dysfunction (EF 19 8%), we measured LAVI by the biplane area-length method from apical 4 and 2-chamber views (indexed for body surface area). PkVO2 was measured by metabolic cart during maximal exercise and further adjusted to lean body mass (PkVO2lean). We have previously demonstrated that PkVO2lean cutoff of 19 ml/kg/min is better predictor of event free survival than unadjusted PkVO2. Results: In patients whose PkVO2lean was 19 ml/kg/min, the mean LAVI was 44.8 ml/m whereas LAVI was 54.7 ml/m2 in patients with PkVO2lean 19 ml/kg/min (p 0.04). An LAVI 65 ml/m 2 predicts PkVO2lean 19 ml/kg/min with a positive predictive value of 77% and a negative predictive value of 68%. Conclusions: Left atrial volume, a simple echocardiographic parameter, provides discriminatory prediction for functional circulatory impairment further in patients with severe systolic dysfunction. Thus, this investigation suggests that the finding of an increased left atrial volume index 65ml/m reflects worse diastolic dysfunction and should prompt assessment of metabolic reserve by cardiopulmonary stress testing.