Background:E/E ratio is known to the parameter which can predict cardiac events in patients with with advanced heart failure. However, it has a limitation to interpretate the clinical meaning in patients with low ejection fraction. Objective:We assessed the clinical usefulness of LAVi/A���to predict adverse cardiac events in patients with New York Heart function class (NHYA) III or IV. Methods: We enrolled 131 patients with NYHA III or IV and sinus rhythm (mean age 65.5짹14.9yrs,49.6% men) who underwent Doppler echocardiography and B-type natriuretic peptide measurement. We compared the incidence of the composite events, which were defined as cardiac death or re-hospitalization for heart failure (HF), based on LAVi/A' median value of 5.0. Using multiple regression analysis, we identified the independent predictors of clinical outcomes. Results: During a median follow-up of 18.5짹9.3 months, the incidence of composit events was 19.8% (cardiac death, n=5: rehospitalization, n=23).The patients of LAVi/A���5 had a higher BNP level(1053 vs. 503 pg/ml), lower ejection fraction (50.1 vs. 40.3%), and higher E/E' (21.1 vs. 12.1) (all of them, p<0.001) than those of LAVi/A'<5. In Kaplan-Meier curves, the incidence of composite events was higher in patients with LAVi/A'���5 than those with LAVi/A'<5 (log-rank:p<0.05). In Cox proportional hazards analysis, LAVi/A'���5 (OR:5.28,95%CI 1.24-6.51,p=0.05), EF(OR:1.05,95%CI 1.001-1.10,p=0.044), hemoglobin (OR:0.67,95%CI 0.57-0.78,p=0.029) were independent predictors of clinical outcomes. Conclusion: LAVi/A'���5 is a useful parameter to predict clinical outcomes in patients with advanced HF