Iranian Heart Journal

Iranian Heart Journal

Left Atrial Volume Index as a Predicting Factor for the Severity of Acute Coronary Syndrome

Document Type : Original Article

Authors
Ahmed I. Bedier 1
Mohamed Taher 2
Ensaf Bassam 1
Mohammed Hamza Kabil 3
Sally M. Teima 1
1 Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
2 Cardiology Department, Faculty of Medicine, Damietta University, Damietta, Egypt.
3 Cardiology Department, Faculty of Medicine, Suez University, Suez, Egypt.
Abstract
Background: Coronary artery disease (CAD) is a predominant contributor to global mortality. The left atrial volume index (LAVI) is a recognized marker of chronic diastolic dysfunction and has been linked to unfavorable outcomes in patients with acute coronary syndrome (ACS). This study explored the association between echocardiographic parameters and the angiographic complexity of CAD in patients presenting with ACS.
 
Methods: This prospective cohort study enrolled 52 patients diagnosed with ACS who were treated with percutaneous coronary intervention. Each participant underwent a comprehensive echocardiographic evaluation, including measurement of LAVI, and coronary angiography with SYNTAX score calculation.
 
Results: The majority of patients (n = 52) were male (94.2%) with a mean age of 57.3 ± 9.0 years. Single-vessel disease was detected in 78.8%, and low SYNTAX scores (>22) in 86.5%. LAVI correlated positively with age (r = 0.333; P = 0.016), left anterior descending artery diameter (r = 0.840; P < 0.001), left atrial volume A2 (r = 0.904; P < 0.001), left atrial volume A4 (r = 0.913; P < 0.001), and SYNTAX categories (r = 0.337; P = 0.015). Two-vessel disease (adjusted odds ratio, 15.4 [95% CI, 1.4 to 165.3]; P = 0.024) and age greater than 68 years (AOR, 24.0 [95% CI, 1.2 to 489.6]; P = 0.039) independently predicted more severe CAD.
 
Conclusions: LAVI correlates with coronary complexity in ACS. Age and multivessel disease predict more severe CAD, supporting the prognostic value of echocardiographic assessment. (Iranian Heart Journal 2025; 26(4): 46-56)
Keywords
Acute coronary syndrome
Left atrial volume index
Coronary artery disease
SYNTAX score
Echocardiography
  1. Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. Journal of the American College of Cardiology. 2018/05/08/ 2018; 71(18):2015-2040. doi:https://doi.org/10.1016/j.jacc.2017.12.068
  2. Kotecha T, Rakhit RD. Acute coronary syndromes. Clin Med (Lond). Dec 2016;16(Suppl 6):s43-s48. doi:10.7861/clinmedicine.16-6-s43
  3. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. Jul 2016;4(13):256. doi:10.21037/atm.2016.06.33
  4. Hsiao SH, Chiou KR, Porter TR, et al. Left atrial parameters in the estimation of left ventricular filling pressure and prognosis in patients with acute coronary syndrome. Am J Cardiol. Apr 15 2011;107(8):1117-24. doi:10.1016/j.amjcard.2010.12.008
  5. Shin SH, Claggett B, Inciardi RM, et al. Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc. Aug 3 2021;10(15):e019545. doi:10.1161/jaha.120.019545
  6. Galderisi M. Diagnosis and management of left ventricular diastolic dysfunction in the hypertensive patient. Am J Hypertens. May 2011;24(5):507-17. doi:10.1038/ajh.2010.235
  7. Mehrzad R, Rajab M, Spodick DH. The three integrated phases of left atrial macrophysiology and their interactions. International journal of molecular sciences. Aug 27 2014;15(9):15146-60. doi:10.3390/ijms150915146
  8. Moller JE, Hillis GS, Oh JK, et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation. May 6 2003;107(17):2207-12. doi:10.1161/01.Cir.0000066318.21784.43
  9. Wenger NK. What US Cardiology Can Learn From the 2023 ESC Guidelines for the Management of Acute Coronary Syndromes. Clin Cardiol. Aug 2024;47(8):e24329. doi:10.1002/clc.24329
  10. Nam CW, Mangiacapra F, Entjes R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol. Sep 13 2011;58(12):1211-8. doi:10.1016/j.jacc.2011.06.020
  11. Atmakuri SR, Lev EI, Alviar C, et al. Initial experience with a magnetic navigation system for percutaneous coronary intervention in complex coronary artery lesions. J Am Coll Cardiol. Feb 7 2006;47(3):515-21. doi:10.1016/j.jacc.2005.11.017
  12. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. Aug 2005;1(2):219-27.
  13. Shahjehan RD, Sharma S, Bhutta BS. Coronary Artery Disease. StatPearls. StatPearls Publishing

Copyright © 2025, StatPearls Publishing LLC.; 2025.

  1. Dalen JE, Alpert JS, Goldberg RJ, Weinstein RS. The epidemic of the 20(th) century: coronary heart disease. Am J Med. Sep 2014;127(9):807-12. doi:10.1016/j.amjmed.2014.04.015
  2. Eisen A, Giugliano RP, Braunwald E. Updates on Acute Coronary Syndrome: A Review. JAMA Cardiol. Sep 1 2016;1(6):718-30. doi:10.1001/jamacardio.2016.2049
  3. Simons M, Alpert J, Cannon C. Acute coronary syndrome: Terminology and classification. UpToDate Com. 2020;
  4. Christersson C, Baron T, Flachskampf F, Lindhagen L, Lindahl B, Siegbahn A. Screening for Biomarkers Associated with Left Ventricular Function During Follow-up After Acute Coronary Syndrome. J Cardiovasc Transl Res. Feb 2023;16(1):244-254. doi:10.1007/s12265-022-10285-2
  5. Secundo Junior JA, Santos MA, Faro GB, et al. Left atrial volume index and prediction of events in acute coronary syndrome: Solar Registry. Arq Bras Cardiol. Oct 2014;103(4):282-91. doi:10.5935/abc.20140122
  6. Harjola VP, Parissis J, Bauersachs J, et al. Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. Aug 2020;22(8):1298-1314. doi:10.1002/ejhf.1831
  7. Zhang X, Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A. Interpreting Diastolic Dynamics and Evaluation through Echocardiography. Life (Basel). Sep 12 2024;14(9)doi:10.3390/life14091156
  8. Truong QA, Bamberg F, Mahabadi AA, et al. Left atrial volume and index by multi-detector computed tomography: comprehensive analysis from predictors of enlargement to predictive value for acute coronary syndrome (ROMICAT study). Int J Cardiol. Jan 21 2011;146(2):171-6. doi:10.1016/j.ijcard.2009.06.029
  9. Ahmeti A, Bytyçi FS, Bielecka-Dabrowa A, Bytyçi I, Henein MY. Prognostic value of left atrial volume index in acute coronary syndrome: A systematic review and meta-analysis. Clin Physiol Funct Imaging. Mar 2021;41(2):128-135. doi:10.1111/cpf.12689
  10. Nabati M, Golshani S, Taghavi M, Alipour A, Parsaee H. The association between tissue doppler-derived E/(e's') ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome. BMC Cardiovasc Disord. Feb 22 2023;23(1):98. doi:10.1186/s12872-023-03128-8
  11. Saklecha A, Kapoor A, Sahu A, et al. Is Indexed Left Atrial Volume (LAVI) in Indian Patients with Acute Coronary Syndrome (ACS) undergoing revascularization a predictor of cardiovascular outcomes? Ann Card Anaesth. Jan-Mar 2022;25(1):19-25. doi:10.4103/aca.ACA_129_20
  12. Gunasekaran R, Maskon O, Hassan HH, Safian N, Sakthiswary R. Left atrial volume index is an independent predictor of major adverse cardiovascular events in acute coronary syndrome. Can J Cardiol. Sep-Oct 2012;28(5):561-6. doi:10.1016/j.cjca.2012.02.015
  13. Li YT, Shen WQ, Duan X, et al. Left atrial strain predicts risk and prognosis in patients with acute coronary syndrome: A retrospective study with external validation. Heliyon. Nov 2022;8(11):e11276. doi:10.1016/j.heliyon.2022.e11276
Iranian Heart Journal
Volume 26, Issue 4
Autumn 2025
Pages 46-56