Journal
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Volume 14, Issue 2, Pages 118-126Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jes118
Keywords
Magnetic resonance imaging; Acute myocardial infarction; Left atrium function; Diastolic function; Prognosis
Funding
- Danish Heart Foundation
- Rigshospitalet Research Foundation
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The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is based almost exclusively on LA maximal volume (LAmax), which may not glean the full prognostic potential. Cardiovascular magnetic resonance (CMR) is considered the most accurate method for studying LA function and size. The aim of the present study was to evaluate the prognostic importance of LA function in patients following ST elevation myocardial infarction (STEMI). In 199 patients, a CMR scan was performed within 13 days after STEMI to measure LAmax and minimal volume (LAmin) and LA function. The incidence of death, re-infarction, stroke, and admission for heart failure [major adverse cardiac event (MACE)] were registered during the follow-up period [2.3 years (inter-quartile range: 2.02.5)]. A total of 40 patients (20) met the clinical endpoint of MACE during follow-up. In a Cox regression analysis adjusting for known risk factors, LA fractional change remained independently associated with MACE [adjusted hazard ratio: 0.66 (95 confidence interval: 0.460.95)]. LAmax, LAmin, or LA passive fraction was not independently associated with MACE. Furthermore, LA fractional change provided incremental prognostic value to LAmax and other known predictors (Wald (2) 31.0 vs. 39.9, P 0.016). In STEMI patients, impaired LA fractional change is independently associated with outcome and provide incremental prognostic information to established predictors including LAmax.
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