title: Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction.
abstract: OBJECTIVE
  To investigate the impact of myocardial perfusion on left atrial remodeling and its determinants after primary percutaneous coronary intervention for acute myocardial infarction.
  
  
  BACKGROUND
  Left atrial volume is an important predictor of morbidity and mortality in acute myocardial infarction, while thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade is an angiographic index associated with infarct size and mortality. As yet, however, the relationship between TMP grade and left atrial remodeling has not been investigated.
  
  
  METHODS
  Conventional transthoracic echocardiography was performed in 105 patients (55+/-13 years old, 92 men) with acute myocardial infarction within 24 h and after 6 months (mean 9+/-4, range 6-29 months) following successful primary percutaneous coronary intervention. Absolute left atrial volume was calculated using an elliptical model. Myocardial perfusion was evaluated, using TMP grade, by visual assessment on the coronary angiogram. Patients were divided into three groups on the basis of myocardial perfusion status, as TMP 0/1 (n=36), TMP 2 (n=36) and TMP 3 (n=33).
  
  
  RESULTS
  No difference was observed between baseline and follow-up left atrial volumes in the overall study population (42.5+/-16.1 vs. 43.5+/-17.4 ml, P=0.519). As regards TMP grade, follow-up left atrial volume significantly increased in the TMP 0/1 group (43+/-17 vs. 54.6+/-1.1 ml, P<0.001) and significantly decreased in the TMP 3 group (42.9+/-15.7 vs. 35.5+/-12.2 ml, P=0.001) compared with initial values. No change was observed in left atrial volume in the TMP 2 group. Multivariate analysis showed that TMP grade (P<0.001) and anterior location of myocardial infarction (P<0.001) were independent determinants of left atrial remodeling.
  
  
  CONCLUSIONS
  These results suggest that poor myocardial perfusion and anterior location of myocardial infarction can affect left atrial remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. It appears that adequate myocardial perfusion is crucial to prevent left atrial remodeling, a poor prognostic factor in acute myocardial infarction.
authors.affiliation: Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea.
authors.forename: Sung-Gyun
authors.initials: SG
authors.lastname: Ahn
authors.forename: Joon-Han
authors.initials: JH
authors.lastname: Shin
authors.forename: Bo-Ram
authors.initials: BR
authors.lastname: Koh
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Byoung-Joo
authors.initials: BJ
authors.lastname: Choi
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Yoon
authors.forename: Gyo-Seung
authors.initials: GS
authors.lastname: Hwang
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016279:Atrial Function, Left; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009929:Organ Size; D011379:Prognosis; D016896:Treatment Outcome