title: Risk stratification for recurrent heart failure in patients post-myocardial infarction with electrocardiographic and echocardiographic left atrial abnormality.
abstract: Left atrial enlargement is predictive of cardiovascular events. The predictive power, however, of the combination of electrocardiographic (LAE-ECG) and echocardiographic left atrial enlargement (LAE-Echo) has not been extensively evaluated. We prospectively identified patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) who developed new-onset heart failure during admission. Baseline electrocardiograms obtained < or =12 months before admission were evaluated for LAE-ECG, such as prolonged P-wave duration or positive P-wave terminal force in lead V1, and in-hospital echocardiographic reports obtained < or =1 month after admission were assessed for linear, anteroposterior LAE-Echo. Follow-up was directed toward pertinent cardiovascular events and death. Of the 462 patients with NSTEMI, 108 developed new-onset heart failure (23%); 71 patients had LAE-Echo. Follow-up was 23.2 months (mean 22.1 months). Although in-hospital (early) cardiovascular complications (other than heart failure) were not significantly higher in patients with LAE-Echo, these patients demonstrated more postdischarge (late) cardiovascular complications, predominantly recurrent heart failure. In addition, those with a combination of LAE-Echo and LAE-ECG demonstrated significantly higher recurrence of heart failure (hazard ratio 1.52, 95% confidence interval 1.12 to 4.35; p = 0.02 for interatrial conduction delay, and hazard ratio 1.07, 95% confidence interval 1.01 to 3.27 for P-wave terminal force in lead V1; p = 0.03) and increased mortality compared with those with LAE-Echo alone. In conclusion, our data suggest that a combination of electrical and mechanical left atrial dysfunction is significantly more predictive of increased cardiovascular events and mortality compared with left atrial mechanical dysfunction alone.
authors.affiliation: Division of Cardiology, Department of Medicine, St. Boniface General Hospital/University of Manitoba, Winnipeg, Manitoba. vignendra@hotmail.com
authors.forename: Vignendra
authors.initials: V
authors.lastname: Ariyarajah
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinski
authors.forename: Shelley
authors.initials: S
authors.lastname: Zieroth
authors.forename: Robert
authors.initials: R
authors.lastname: Harizi
authors.forename: Andrew
authors.initials: A
authors.lastname: Morris
authors.forename: David H
authors.initials: DH
authors.lastname: Spodick
mesh_terms: D000368:Aged; D016275:Atrial Function / Q000502:physiology*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors