Long-term prognostic significance of left atrial volume in acute myocardial infarction

Roy Beinart, Valentina Boyko, Ehud Schwammenthal, Rafael Kuperstein, Alex Sagie, Hanoch Hod, Shlomo Matetzky, Solomon Behar, Michael Eldar, Micha S. Feinberg*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives The aim of this study was to evaluate the significance of increased left atrial (LA) volume determined within the first 48 h of admission as a long-term predictor of outcome in patients with acute myocardial infarction (MI). Background The LA volume reflects left ventricular (LV) diastolic properties. Whereas other LV Doppler diastolic characteristics are influenced by acute changes in LV function, LA volume is stable and reflects diastolic properties before MI. Methods Clinical and echocardiographic parameters were prospectively collected in 395 consecutive patients with acute MI. Patients with LA volume index (LAVI) >32 ml/m2 (normal + 2 standard deviations) were compared with those with LAVI ≤32 ml/m2. Independent clinical and echocardiographic prognostic risk factors for five years' mortality were determined by the Cox proportional hazard model. Results Left atrial volume index >32 ml/m2 was found in 63 patients (19%) who had a higher incidence of congestive heart failure on admission (24% vs. 12%, p < 0.01), a higher incidence of mitral regurgitation, increased LV dimensions, and reduced LV ejection fraction when compared with patients with LAVI ≤32 ml/m2. Their five-year mortality rate was 34.5% versus 14.2% (p < 0.001). Significant independent risk predictors of five years' mortality were age (10 years) (odds ratio [OR] 1.45; 95% confidence interval [CI]1.14 to 1.86), Killip class ≥2 on admission (OR 2.30; 95% CI 1.29 to 4.09), LAVI >32 ml/m2 (OR 2.22; 95% CI 1.25 to 3.96), diabetes (OR 1.94; 95% CI 1.15 to 3.28), and LV restrictive filling pattern (OR 1.89; 95% CI 1.09 to 3.31). Conclusions In patients with acute MI, increased LA volume, determined within the first 48 h of admission, is an independent predictor of five-year mortality with incremental prognostic information to clinical and echocardiographic data.

Original languageEnglish
Pages (from-to)327-334
Number of pages8
JournalJournal of the American College of Cardiology
Volume44
Issue number2
DOIs
StatePublished - 21 Jul 2004
Externally publishedYes

Keywords

  • BSA
  • LA
  • LAVI
  • LV
  • LVEF
  • MI
  • MR
  • body surface area
  • left atrial
  • left atrial volume index
  • left ventricle
  • left ventricular ejection fraction
  • mitral regurgitation
  • myocardial infarction

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