Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular
Alessandra Meris1, Maria Amigoni, Hajime Uno
1Cardiovascular Division, Brigham and Women's Hospital, MA, USA.
Insights
Left atrial size predicts adverse outcomes after high-risk myocardial infarction (MI). Early LA enlargement in the first month post-MI is linked to increased risk of death or heart failure hospitalization.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Outcomes
Background:
- Left ventricular (LV) dysfunction and heart failure (HF) are common after myocardial infarction (MI).
- Left atrial (LA) size is a potential indicator of cardiac health and remodeling.
Purpose of the Study:
- To evaluate the association between LA size and outcomes in high-risk MI patients.
- To investigate dynamic changes in LA size over long-term follow-up.
Main Methods:
- Prospective enrollment of 610 patients from the VALIANT Echocardiography study post-MI.
- Assessment of LA volume indexed to body surface area (LAVi) at baseline, 1 month, and 20 months.
- Statistical analysis to identify predictors of outcomes and LA remodeling.
Main Results:
- Baseline LAVi independently predicted all-cause death or HF hospitalization (P = 0.004).
- LA volume increased in patients surviving to 20 months, with early enlargement linked to adverse events.
- Hypertension, reduced eGFR, and LV mass predicted LA remodeling, which correlated with worsening mitral regurgitation and LV volumes.
Conclusions:
- Baseline LA size is a significant predictor of mortality and HF hospitalization post-high-risk MI.
- LA remodeling within the first month after MI is associated with poorer clinical outcomes.
Aims:
To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up.
Methods And Results:
The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricular (LV) dysfunction, heart failure (HF), or both following MI. We assessed LA volume indexed to body surface area (LAVi) at baseline, 1 month, and 20 months after MI. Baseline LAVi was an independent predictor of all-cause death or HF hospitalization (P = 0.004). In patients who survived to 20 months, LAVi increased a mean of 3.00 +/- 7.08 mL/m(2) from baseline. Hypertension, lower estimated glomerular filtration rate, and LV mass were the only baseline independent predictors of LA remodelling. Changes in LA size were related to worsening in MR and increasing in LV volumes. LA enlargement during the first month was significantly greater in patients who subsequently died or were hospitalized for HF than in patients without events.
Conclusion:
Baseline LA size is an independent predictor of death or HF hospitalization following high-risk MI. Moreover, LA remodelling during the first month after infarction is associated with adverse outcome.
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