Increased left atrial volume index is associated with more cardiovascular events in patients with acute coronary syndrome: HIJ-PROPER study findings

Echocardiography. 2022 Feb;39(2):260-267. doi: 10.1111/echo.15301. Epub 2022 Jan 18.


Aim: To investigate the association between the left atrial volume index (LAVI) and the incidence of cardiovascular events in patients with acute coronary syndrome (ACS) who did not have atrial fibrillation (AF).

Methods: In this sub-analysis of the HIJ-PROPER study, 226 ACS patients who did not have a history of AF were enrolled. Participants were divided into two groups according to the LAVI cut-off level calculated by receiver operating characteristic (ROC) curve analysis to predict the primary endpoint, and cardiovascular events were compared between groups. The primary endpoint was the first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure.

Results: ROC curve analysis for the occurrence of composite of cardiovascular events indicated a LAVI cut-off point of 34 mL/m2 . Based on this, 131 patients (58.0%) were in the LAVI < 34 mL/m2 group and 95 (42.0%) were in the LAVI ≥ 34 mL/m2 group. Over a median follow-up period of 4.0 years [interquartile range: 3.2, 5.1], cardiovascular events were noted in 7 and 15 patients in the LAVI < 34 mL/m2 and LAVI ≥ 34 mL/m2 groups, corresponding to an incidence rate of 5.3% and 15.8%, respectively. Patients with a LAVI value ≥ 34 mL/m2 had a significantly higher risk of cardiovascular events than those with a LAVI value < 34 mL/m2 (hazard ratio: 2.93; 95% confidence interval: 1.19-7.22; P = .014). The tendency was similar after adjusting for several confounders (P = .025).

Conclusion: In ACS patients without AF, elevated LAVI was associated with increased cardiovascular events.

Clinical trial registration: International standard randomized controlled trial (URL:; UMIN000002742).

Keywords: acute coronary syndrome; cardiovascular events; left atrial volume index.

MeSH terms

  • Acute Coronary Syndrome* / complications
  • Acute Coronary Syndrome* / diagnostic imaging
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / diagnostic imaging
  • Heart Atria / diagnostic imaging
  • Heart Failure* / complications
  • Heart Failure* / diagnostic imaging
  • Humans
  • Incidence
  • Myocardial Infarction*