Left Atrial Volume Index (LAVI)

Left Atrial Volume Index Explained

Left Atrial Volume Index (LAVI) has been found to correlate with mortality from cardiovascular disease and may be measured at the end-ventricular systole, when the LA is at its maxim size. Gender differences are then accounted for by indexing the volume to body surface area (BSA) via the Mosteller equation.

• LA Volume = (8 /3 π) x (A1 x A2 / L) = 0.85 x (A1 x A2 / L)
• LAVI = LA Volume / BSA

Where:

• A₁ = planimetered LA area in apical 4-chamber (A4C) view;
• A₂ = Max. planimetered LA area in apical 2-chamber (A2C) view;
• L = the LA long-axis length determined as the distance of the perpendicular line measured from the middle of the plane of the mitral annulus to the superior aspect of the LA.

The increases from the normal left atrial volume index may be interpreted as follows:

Left Atrial Volume Index was found to predict mortality risk, independent of LV geometry in a large cohort of patients with preserved systolic function.

Abnormal LV geometry and mortality were significantly higher in patients with increased LAVI, who had a 42% increased risk of mortality (those with severe LAVI).

In patients with normal LV geometry or concentric remodeling, a severe LAVI carried an increased mortality risk of 28% and 46%, respectively.

Increased LAVI was also found to be a powerful predictor of mortality after acute myocardial infarction (AMI), where Doppler variables are affected by multiple factors and may change rapidly, since LAVI is less influenced by acute changes and reflects subacute or chronic diastolic function.

References

Lang RM, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1):1-39.

Lester SJ, et al. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol 1999; 84:829-32.

Pritchett AM, Redfield MM, et al. Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 2003; 41:1036-43.

Patel DA, Lavie CJ, Milani RV, Ventura HO. Left atrial volume index predictive of mortality independent of left ventricular geometry in a large clinical cohort with preserved ejection fraction. Mayo Clin Proc. 2011; 86(8):730-7.

Moller JE, Hillis GS, Oh JK, et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation. 2003; 107(17):2207-2212.