title: Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise.
abstract: BACKGROUND
  Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides.
  
  
  METHODS
  62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m2within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test.
  
  
  RESULTS
  LA remodeling was considered in patients with a change from mild (35-41ml/m2), to severe (>48ml/m2) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred.
  
  
  CONCLUSIONS
  Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.
authors: Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: Rine.Bakkestroem@rsyd.dk.
authors: Rine
authors: R
authors: Bakkestrøm
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: Mads J
authors: MJ
authors: Andersen
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: Mads
authors: M
authors: Ersbøll
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: John
authors: J
authors: Bro-Jeppesen
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: Finn
authors: F
authors: Gustafsson
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: Lars
authors: L
authors: Køber
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
authors: Christian
authors: C
authors: Hassager
authors: From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors: Jacob E
authors: JE
authors: Møller
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology*; D064752:Atrial Remodeling / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology*; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology*; D012146:Rest / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*
keywords: Acute myocardial infarction; Diastolic dysfunction echocardiography; Hemodynamic stress; Left atrial volume index; Remodeling