Predictors and prognostic value of left atrial remodelling after acute myocardial infarction
Kasper Kyhl1, Niels Vejlstrup2, Jacob Lønborg2
1Department of Cardiology , Rigshospitalet , Copenhagen, Denmark ; Department of Biomedical Sciences , Copenhagen University , Copenhagen , Denmark.
Insights
Left atrial remodelling after ST-segment elevation myocardial infarction (STEMI) is linked to adverse outcomes. Larger infarct size predicts adverse LA remodelling, highlighting its prognostic importance.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac MRI
Background:
- Left atrial (LA) volume is a key prognostic indicator post-ST-elevation myocardial infarction (STEMI).
- LA remodelling, the change in LA volume over time, is poorly understood in this context.
- Predictors and prognostic significance of LA remodelling post-STEMI require further investigation.
Purpose of the Study:
- To identify predictors of LA remodelling following STEMI.
- To evaluate the prognostic importance of LA remodelling in STEMI patients.
- To understand the relationship between ventricular and atrial changes post-MI.
Main Methods:
- Subgroup analysis of a randomized trial on exenatide treatment in STEMI patients.
- Cardiovascular magnetic resonance (CMR) imaging performed at 2 days and 3 months post-primary angioplasty.
- LA remodelling defined by changes in LA volume/function; major adverse cardiac events tracked over 5.2 years.
Main Results:
- Adverse LA minimum volume remodelling correlated with hypertension, larger infarct size, higher peak troponin T, larger area at risk, and adverse left ventricular (LV) remodelling.
- Adverse LA maximum volume remodelling correlated with larger infarct size, higher peak troponin T, larger area at risk, increased LV mass, impaired LV function, and adverse LV remodelling.
- Patients in the highest tertiles of LA minimum or maximum volume remodelling faced significantly higher risks.
Conclusions:
- LA remodelling post-myocardial infarction mirrors parallel ventricular-atrial remodelling.
- Infarct size is a primary driver of LA remodelling after STEMI.
- Adverse LA remodelling is a significant indicator of an unfavorable prognosis in STEMI patients.
Purpose:
Left atrial (LA) volume is a strong prognostic predictor in patients following ST-segment elevation myocardial infarction (STEMI). However, the change in LA volume over time (LA remodelling) following STEMI has been scarcely studied. We sought to identify predictors for LA remodelling and to evaluate the prognostic importance of LA remodelling.
Methods:
This is a subgroup analysis from a randomised clinical trial that evaluated the cardioprotective effect of exenatide treatment. A total of 160 patients with STEMI underwent a cardiovascular MR (CMR) 2 days after primary angioplasty and a second scan 3 months later. LA remodelling was defined as changes in LA volume or function from baseline to 3 months follow-up. Major adverse cardiac events were registered after a median of 5.2 years.
Results:
Adverse LA minimum volume (LAmin) remodelling was correlated to the presence of hypertension, larger infarct size by CMR, higher peak troponin T, larger area at risk and adverse left ventricular (LV) remodelling. LA maximum volume (LAmax) remodelling was correlated to larger infarct size by CMR, higher peak troponin T, larger area at risk, larger LV mass, impaired LV function and adverse LV remodelling. Kaplan-Meier and Log Rank analyses showed that patients in the highest tertiles of LAmin or LAmax remodelling are at higher risk (0.030 and p=0.018).
Conclusions:
After a myocardial infarction, LA remodelling reflects a parallel ventricular-atrial remodelling. Infarct size is a major determinant of LA remodelling following STEMI and adverse LA remodelling is associated with an unfavourable prognosis.
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