Enlarged left atrium is a simple and strong predictor of poor prognosis in patients after myocardial infarction.
OBJECTIVE
Patients after myocardial infarction (MI) differ according to the extend of myocardial damage and prognosis. Diastolic function impairment may have great impact on development of heart failure and outcomes. We evaluated the prognostic value of various echocardiographic measurements in 18-month and 3-year observation after MI.


METHODS
60 patients after MI (44 male, mean age 60 +/- 11) were examined by transthoracic echocardiography with the assessment of wide spectrum of parameters. Mortality and combined end points (cardiac deaths and heart failure exacerbation) were assessed after 18-month and 3-year observation and groups with and without end points were compared. Optimal cutoff values were estimated by receiver operating characteristic (ROC) analysis and resulting Kaplan-Meier curves were compared.


CONCLUSIONS
After 18 months, 11 deaths occurred and 20 subjects experienced hospitalization caused by heart failure exacerbation. Although the group with cardiac events showed a greater enlargement of the left ventricle and lower ejection fraction, the highest relative risk of poor outcome (RR = 5.0) was related to the left atrial enlargement above 44 mm. Although restrictive or pseudonormal inflows were connected with 2.1 relative risk of combined end point, all patients with E deceleration time < or = 130 ms experienced heart failure exacerbation or death. Despite tissue Doppler and propagation parameters describing elevated end-diastolic pressure differed between groups with various outcomes in multivariate analysis, only enlarged left atrium was an independent predictor for both combined end point and cardiac death. Further 3-year follow-up solely confirmed the role of above described predictors.
Wierzbowska-Drabik
Karina
K
II Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland. wierzbowska@ptkardio.pl
Krzemińska-Pakula
Maria
M
Drozdz
Jarosław
J
Plewka
Michał
M
Trzos
Ewa
E
Kurpesa
Malgorzata
M
Rechciński
Tomasz
T
Rózga
Aneta
A
Plońska-Gościniak
Edyta
E
Kasprzak
Jarosław D
JD
D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis