Journal of the American Society of Echocardiography
Clinical InvestigationCoronary Heart DiseaseComprehensive Assessment of Changes in Left Atrial Volumes and Function after ST-Segment Elevation Acute Myocardial Infarction: Role of Two-Dimensional Speckle-Tracking Strain Imaging
Section snippets
Patient Population and Protocol
The study population included 407 patients from an ongoing clinical registry (MISSION!) with ST-segment elevation AMI who were treated with primary percutaneous coronary intervention.5 Clinical and echocardiographic data were prospectively entered into the departmental cardiology information system (EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands) and the echocardiography database, respectively, and retrospectively analyzed.5, 6 All patients were treated according to the
Baseline Characteristics of the Patient Population
A total of 407 consecutive patients were evaluated. Baseline clinical characteristics of the patients are summarized in Table 1. The mean age was 60 ± 11 years, and most patients were men (n = 317 [78%]). Twenty-five patients (6%) had prior myocardial infarction, and in almost half of the patients (n = 184 [45%]), the left anterior descending coronary artery was the culprit vessel. Baseline echocardiographic characteristics are summarized in Table 2. All patients were treated with primary
Discussion
The main findings of the current study can be summarized as follows: (1) During 1-year follow-up after AMI, 25% of the patients developed LA remodeling (defined as an increase of ≥8 mL/m2 in LA maximal volume, corresponding to the highest quartile of the population); (2) besides LA max, LA strain assessed early after AMI was an independent predictor of the occurrence of LA remodeling at 1-year follow-up; and (3) in patients without LA remodeling, no changes in LA function were observed.
Conclusions
In the present study, 25% of patients demonstrated LA remodeling, defined as an increase of ≥8 mL/m2 in LA maximal volume during 1-year follow-up after AMI. The presence of LA remodeling was associated with deterioration in LA function assessed with phasic changes in LA volumes and novel speckle-tracking LA strain. Baseline LA max and LA strain were identified as independent predictors of LA remodeling at 1-year follow-up.
References (22)
- et al.
Long-term prognostic significance of left atrial volume in acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Prognostic importance of atrial fibrillation in implantable cardioverter-defibrillator patients
J Am Coll Cardiol
(2010) - et al.
2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2009) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
(2003) - et al.
Comparison of usefulness of left ventricular diastolic versus systolic function as a predictor of outcome following primary percutaneous coronary angioplasty for acute myocardial infarction
Am J Cardiol
(2006) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
J Am Soc Echocardiogr
(2009) - et al.
Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications
Am Heart J
(2008) - et al.
Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function
J Am Soc Echocardiogr
(2004) - et al.
Left atrial enlargement and phasic function in patients following non-ST elevation myocardial infarction
J Am Soc Echocardiogr
(2010)
Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function
J Am Soc Echocardiogr
Cited by (0)
Dr. Schalij has received grants from Boston Scientific, Medtronic, and Biotronik. Dr. Bax has received grants from GE Healthcare (Milwaukee, WI), Lantheus Medical Imaging (North Billerica, MA), St. Jude Medical (St. Paul, MN), Medtronic (Minneapolis, MN), Boston Scientific (Natick, MA), Biotronik (Berlin, Germany), and Edwards Lifesciences (Irvine, CA).