Left atrial volume: a powerful predictor of survival after acute myocardial infarction.
BACKGROUND
After acute myocardial infarction (AMI), diastolic function assessed by Doppler echocardiography provides important prognostic information that is incremental to systolic function. However, Doppler variables are affected by multiple factors and may change rapidly. In contrast, left atrial (LA) volume is less influenced by acute changes and reflects subacute or chronic diastolic function. This may be of importance when one assesses risk in patients with AMI.


RESULTS
Three hundred fourteen patients with AMI who had a transthoracic echocardiogram with assessment of left ventricular (LV) systolic and diastolic function and measurement of LA volume during admission were identified. The LA volume was corrected for body surface area, and the population was divided according to LA volume index of 32 mL/m2 (2 SDs above normal). LA volume index was >32 mL/m2 in 142 (45%). The primary study end point was all-cause mortality. During follow-up of 15 (range 0 to 33) months, 46 patients (15%) died. LA volume index was a powerful predictor of mortality and remained an independent predictor (hazard ratio 1.05 per 1-mL/m2 change, 95% CI 1.03 to 1.06, P<0.001) after adjustment for clinical factors, LV systolic function, and Doppler-derived parameters of diastolic function.


CONCLUSIONS
Increased LA volume index is a powerful predictor of mortality after AMI and provides prognostic information incremental to clinical data and conventional measures of LV systolic and diastolic function.
Moller
Jacob E
JE
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA.
Hillis
Graham S
GS
Oh
Jae K
JK
Seward
James B
JB
Reeder
Guy S
GS
Wright
R Scott
RS
Park
Seung W
SW
Bailey
Kent R
KR
Pellikka
Patricia A
PA
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016277:Ventricular Function, Left