Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction.
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.
Ahn
Sung-Gyun
SG
Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea.
Shin
Joon-Han
JH
Koh
Bo-Ram
BR
Choi
Jung-Hyun
JH
Kang
Soo-Jin
SJ
Choi
Byoung-Joo
BJ
Choi
So-Yeon
SY
Yoon
Myeong-Ho
MH
Hwang
Gyo-Seung
GS
Tahk
Seung-Jea
SJ
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