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J Am Coll Cardiol, 2004; 44:327-334, doi:10.1016/j.jacc.2004.03.062
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: PROGNOSTIC MARKERS IN ACUTE MI

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

Roy Beinart, MD*, Valentina Boyko, MSc{dagger}, Ehud Schwammenthal, MD*, Rafael Kuperstein, MD*, Alex Sagie, MD{ddagger}, Hanoch Hod, MD, FACC*, Shlomo Matetzky, MD*, Solomon Behar, MD{dagger}, Michael Eldar, MD, FACC* and Micha S. Feinberg, MD, FACC*,*

* Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
{dagger} Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel
{ddagger} Cardiology Department, Rabin Medical Center, Petach Tiqvah, Israel

Manuscript received January 15, 2004; revised manuscript received March 16, 2004, accepted March 22, 2004.

* Reprint requests and correspondence: Dr. Micha S. Feinberg, Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.
micha.feinberg{at}sheba.health.gov.il

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.

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




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