Clinical Investigation
Coronary Heart Disease
Comprehensive Assessment of Changes in Left Atrial Volumes and Function after ST-Segment Elevation Acute Myocardial Infarction: Role of Two-Dimensional Speckle-Tracking Strain Imaging

https://doi.org/10.1016/j.echo.2011.06.017Get rights and content

Background

Left atrial (LA) size has been associated with adverse outcome in patients after acute myocardial infarction. However, data about the occurrence of late LA enlargement and changes in LA function during follow-up are scarce. The purpose of the current study was to evaluate changes in LA size and function during 1-year follow-up.

Methods

The study population comprised 407 patients with acute myocardial infarction who were treated with primary percutaneous coronary intervention. At baseline and 12 months, two-dimensional echocardiography was performed to assess LA volumes and function using speckle-tracking strain and strain rate.

Results

The mean age was 60 ± 11 years, and most patients were men (78%). LA maximal volume increased from 25 ± 8 to 28 ± 8 mL/m2 (P < .001) from baseline to 1 year. Echocardiographic assessment at 1-year follow-up showed that 92 patients (25%) had developed LA remodeling (defined as an increase of ≥8 mL/m2 in LA maximal volume). On multivariate analysis, only LA maximal volume at baseline (odds ratio, 0.95; 95% confidence interval, 0.91–0.98; P = .003) and LA strain at baseline (odds ratio, 0.94; 95% confidence interval, 0.92–0.97; P < .001) were independent predictors of LA remodeling during follow-up. Interestingly in patients without LA remodeling, no changes were observed in LA function during follow-up. However, in patients with LA remodeling, LA function significantly worsened during follow-up. In line, LA strain and strain rate were significantly lower at 12 months compared with baseline (24 ± 7% vs 27 ± 6%, P < .001, and 1.8 ± 0.5 vs 2.4 ± 0.7 sec−1, P < .001, respectively).

Conclusions

LA remodeling occurred in 22% of patients after acute myocardial infarction. In patients without LA remodeling, no changes in LA function were observed, but in patients with LA remodeling, LA function deteriorated significantly.

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)

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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).

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