Backgrounds : Volume of left atrium (LA) is a result of chronic loading to LA. Late diastolic mitral annular velocity (A���) is determined by left atrial systole and LV diastolic stiffness. As diastolic function is deteriorated, LA volume is progressively increased and A��� is decreased. Thus, information of A��� with LA volume (LAV) may provide additive effect for the evaluation of diastolic function. Objectives : We assessed the ability of a new echo index, LAVi over A��� (LAVi/A���) for the detection of advanced diastolic dysfunction (pseudonormal or restrictive physiology) and correlated this index with patient���s clinical outcome. Methods: 118 patients (men 71, 60짹13yr) referred for chest discomfort or dyspnea were evaluated by comprehensive Doppler echo. Using ROC analysis, we compared the area under the curves (AUC) for prediction of advanced diastolic dysfunction among BNP, LAVi, and LAVi/A���. All of patients was clinically followed for 13.7 months (median). Overall mortality and the combined end point of morbidity (cardiac death and rehospitalization) were compared according to the cut-off value of LAVi/A' by Kaplan-Meier and log-rank test. Results: The AUC of BNP and LAVi/A��� for the detection of advanced diastolic dysfunction were 0.940 and 0.937 respectively, which were higher than LAVi of 0.879 (p<0.05). LAVi/A��� value of 3.82 represented sensitivity 90% and specificity 92% for prediction of advanced diastolic dysfunction. During the follow-up, overall mortality and the incidence of the combined end point were significantly higher in the group of LAVi/A������3.82 than the other (Figure). Conclusions : LAVi/A��� is a excellent screening echo index for advanced diastolic dysfunction. LAVi/A������3.82 can predict poor clinical outcome.