Left atrial volume and function in patients following ST elevation myocardial infarction and the association with clinical outcome: a cardiovascular magnetic resonance study

• Published in: European heart journal cardiovascular imaging 2013-02, Vol.14 (2), p.118-127
• Main Authors: Lønborg, Jacob Thomsen, Engstrøm, Thomas, Møller, Jacob Eifer, Ahtarovski, Kiril A, Kelbæk, Henning, Holmvang, Lene, Jørgensen, Erik, Helqvist, Steffen, Saunamäki, Kari, Søholm, Helle, Andersen, Mads, Mathiasen, Anders B, Kühl, Jørgen Tobias, Clemmensen, Peter, Køber, Lars, Vejlstrup, Niels
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Atrial Function, Left - physiology; Electrocardiography; Female; Heart Function Tests; Humans; Linear Models; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Organ Size; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Severity of Illness Index; Stroke Volume - physiology; Survival Rate
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jes118

The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is based almost exclusively on LA maximal volume (LAmax), which may not glean the full prognostic potential. Cardiovascular magnetic resonance (CMR) is considered the most accurate method for studying LA function and size. The aim of the present study was to evaluate the prognostic importance of LA function in patients following ST elevation myocardial infarction (STEMI). In 199 patients, a CMR scan was performed within 1-3 days after STEMI to measure LAmax and minimal volume (LAmin) and LA function. The incidence of death, re-infarction, stroke, and admission for heart failure [major adverse cardiac event (MACE)] were registered during the follow-up period [2.3 years (inter-quartile range: 2.0-2.5)]. A total of 40 patients (20%) met the clinical endpoint of MACE during follow-up. In a Cox regression analysis adjusting for known risk factors, LA fractional change remained independently associated with MACE [adjusted hazard ratio: 0.66 (95% confidence interval: 0.46-0.95)]. LAmax, LAmin, or LA passive fraction was not independently associated with MACE. Furthermore, LA fractional change provided incremental prognostic value to LAmax and other known predictors (Wald χ(2) 31.0 vs. 39.9, P= 0.016). In STEMI patients, impaired LA fractional change is independently associated with outcome and provide incremental prognostic information to established predictors including LAmax.