title: Enlarged left atrium is a simple and strong predictor of poor prognosis in patients after myocardial infarction.
abstract: 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.
authors.affiliation: II Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland. wierzbowska@ptkardio.pl
authors.forename: Karina
authors.initials: K
authors.lastname: Wierzbowska-Drabik
authors.forename: Maria
authors.initials: M
authors.lastname: Krzemińska-Pakula
authors.forename: Jarosław
authors.initials: J
authors.lastname: Drozdz
authors.forename: Michał
authors.initials: M
authors.lastname: Plewka
authors.forename: Ewa
authors.initials: E
authors.lastname: Trzos
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Kurpesa
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rechciński
authors.forename: Aneta
authors.initials: A
authors.lastname: Rózga
authors.forename: Edyta
authors.initials: E
authors.lastname: Plońska-Gościniak
authors.forename: Jarosław D
authors.initials: JD
authors.lastname: Kasprzak
mesh_terms: 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