The aim of the study was to assess the power of left atrial expansion index (LAEI) to predict left ventricular filling pressures and its relation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with ischemic cardiomyopathies.

This prospective study analyzed 66 patients (mean age 62±11 years, range 37–89, 86.4% male) with ischemic cardiomyopathy (mean Left ventricular ejection fraction 46.4±12.8%). All patients underwent transthoracic echocardiography and NT-proBNP measurement within 24hours. The LAEI was calculated as (Vol max−Vol min)×100%/Vol min, where Vol max was defined as maximal LA volume and Vol min was defined as minimal volume.

Simple regression analysis demonstrated a significant linear correlation between LAEI and Log NT-proBNP(r=0.723, P<0.0001). Significant but weaker correlations were found between Log NT-proBNP and E/E’ (r=0.504, P<0.0001), indexed LA maximum volume (LAVI max) (r=0.308, P=0.012), mitral deceleration time (TDE) (r=0.365, P=0.003), E/A (r=0.362, P=0.003). Significant correlations were also found between LAEI and E/E’ (r=−0.543, P<0.0001), LAVI max (r=0.360, P=0.003), E/A (r=0.403, P=0.001). The receiver-operating characteristic curve showed that LAEI had good diagnostic power for E/E’>15 at cutoff value of 66.8% with a sensitivity of 74.5% and a specificity of 83.3% while the area under the curve was of 0.875. Multivariate analysis techniques with Log-NT-proBNP as dependent variable and age, E/A, TDE, E/E’, LAVI max and LAEI as predictors, showed that the relation to LAEI was the strongest (β=−0.725).

We suggest that evaluation of LAEI may be useful to predict LV filling pressures in ischemic cardiomyopathies. The power of this index exceeds that of other well-established echocardiographic parameters such as E/E’ and LVAI max.