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Measures of left atrial function predict incident atrial fibrillation in STEMI patients treated with primary

Daniel Modin1, Flemming Javier Olsen1, Sune Pedersen1

  • 1Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.

International Journal of Cardiology
|May 15, 2018
PubMed

Insights

Left atrial emptying fraction (LAEF) and left atrial expansion index (LAi) predict new-onset atrial fibrillation after heart attack. These measures offer better risk prediction than maximal left atrial volume alone.

Area of Science:

  • Cardiology
  • Echocardiography
  • Arrhythmia Research

Background:

  • Atrial fibrillation (AF) is a common complication post-acute myocardial infarction (AMI).
  • Maximal left atrial (LA) volume is currently the sole echocardiographic metric used for AF risk assessment after AMI.

Purpose of the Study:

  • To evaluate the prognostic value of left atrial functional measures, specifically left atrial emptying fraction (LAEF) and left atrial expansion index (LAi), for predicting incident AF in ST-elevation myocardial infarction (STEMI) survivors.
  • To compare the predictive capabilities of LAEF and LAi against maximal LA volume in the post-STEMI population.

Main Methods:

  • Prospective enrollment of 373 STEMI patients treated with primary percutaneous coronary intervention (pPCI).
  • Echocardiographic assessment of LA maximal volume, LA minimal volume, LAEF, and LAi using the area-length method, performed a median of 2 days post-pPCI.
  • Median follow-up of 5.6 years to ascertain incident AF, with 100% follow-up achieved.

Main Results:

  • Incident AF developed in 6% of patients (24/373) over the follow-up period.
  • Multivariable Cox regression and competing risk analysis demonstrated that LAEF and LAi were independent predictors of incident AF.
  • Maximal LA volume did not emerge as an independent predictor of AF after multivariable adjustment.

Conclusions:

  • Left atrial emptying fraction (LAEF) and left atrial expansion index (LAi) independently predict incident AF in the post-STEMI setting.
  • LAEF and LAi provide incremental prognostic information beyond established risk scores like CHARGE-AF and CHA2DS2-VASc for AF prediction.
  • Maximal LA volume lacks independent predictive value for incident AF in this cohort.
Abstract

Keywords:
Acute myocardial infarctionAtrial fibrillationEchocardiographyPredictorPrognosisRisk stratificationSTEMI

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