Long-term prognostic significance of left atrial volume in acute myocardial infarction.
OBJECTIVE
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/m(2) (normal + 2 standard deviations) were compared with those with LAVI <==32 ml/m(2). 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/m(2) 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/m(2). 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/m(2) (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.
Beinart
Roy
R
Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Boyko
Valentina
V
Schwammenthal
Ehud
E
Kuperstein
Rafael
R
Sagie
Alex
A
Hod
Hanoch
H
Matetzky
Shlomo
S
Behar
Solomon
S
Eldar
Michael
M
Feinberg
Micha S
MS
D000368:Aged; D016279:Atrial Function, Left; D002306:Cardiac Volume; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D016277:Ventricular Function, Left