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Related Experiment Video

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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
08:10

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Published on: July 20, 2022

Left atrial function and mortality in patients with NSTEMI an MDCT study.

J Tobias Kühl1, Jacob E Møller, Thomas S Kristensen

  • 1Department of Cardiology, the Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Tobiaskh@gmail.com

JACC. Cardiovascular Imaging
|October 18, 2011
PubMed
Summary

Measures of left atrial (LA) function, specifically fractional change and left atrial ejection fraction (LAEF), independently predict mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). These LA function metrics offer greater prognostic value than LA maximal volume (LAmax).

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Published on: December 28, 2012

Area of Science:

  • Cardiology
  • Medical Imaging
  • Prognostics

Background:

  • Left atrial maximal volume (LAmax) is a known mortality predictor in acute myocardial infarction (AMI).
  • Previous studies suggest left atrial (LA) function (fractional change, LA ejection fraction [LAEF]) may be more clinically relevant than LAmax.
  • Multidetector computed tomography (MDCT) is utilized for assessing LA size and function.

Purpose of the Study:

  • To evaluate if LA function measures are independent predictors of mortality in non-ST-segment elevation myocardial infarction (NSTEMI) patients.
  • To compare the prognostic value of LA function (fractional change, LAEF) against LA maximal volume (LAmax).

Main Methods:

  • Prospective study of 384 NSTEMI patients undergoing MDCT coronary angiography.
  • Measurement of LA size and mechanical function (LAmax, fractional change, LAEF).
  • Follow-up for at least 2 years to determine all-cause mortality, with Cox proportional hazards modeling for analysis.

Main Results:

  • Reduced LA fractional change (HR: 0.65; 95% CI: 0.45-0.94) and LAEF (HR: 0.63; 95% CI: 0.44-0.91) were independent predictors of mortality after adjusting for clinical factors.
  • LAmax did not show a significant association with mortality in this NSTEMI cohort.
  • The study achieved 94% 2-year survival, with 35 deaths (9%) over a median follow-up of 36 months.

Conclusions:

  • In NSTEMI patients, reduced left atrial function (fractional change and LAEF) independently predicts mortality.
  • LA function provides prognostic information incremental to LAmax in this patient group.
  • These findings highlight the importance of assessing LA mechanical function in NSTEMI risk stratification.