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Published on: July 20, 2022
Left Atrial Function Determined by Echocardiography Predicts Incident Heart Failure in Patients With STEMI treated by
Daniel Modin1, Sune Pedersen1, Thomas Fritz-Hansen1
1Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Insights
Left atrial emptying fraction (LAEF) better predicts heart failure and death after myocardial infarction than left atrial volume index (LAVI). Echocardiography shortly after STEMI can identify high-risk patients using LAEF.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Heart failure (HF) is a common complication following ST-elevated myocardial infarction (STEMI).
- Left atrial (LA) volume, assessed by echocardiography, predicts adverse outcomes post-STEMI.
- The prognostic value of LA functional parameters compared to LA volume is not well-established.
Purpose of the Study:
- To compare the effectiveness of LA functional parameters (LAEF, LAi, MinLAVI) against LA volume index (LAVI) in predicting HF and death post-STEMI.
- To determine if LA functional parameters offer superior prognostic information compared to LAVI.
Main Methods:
- Prospective enrollment of 369 patients with STEMI treated with primary percutaneous coronary intervention.
- Echocardiography performed shortly after STEMI to measure maximal and minimal LA volumes.
- Calculation of LAVI, MinLAVI, LAEF, and LAi using the biplane area-length method.
Main Results:
- During a median follow-up of 66 months, 112 patients experienced the composite endpoint of HF or death.
- Adjusted analysis revealed LAEF as an independent predictor of adverse outcomes (HR 1.25, P=0.043 per 1 SD decrease).
- LAVI did not independently predict the composite outcome (HR 1.01, P=0.91 per 1 SD increase).
Conclusions:
- Echocardiographic LAEF shortly after STEMI is superior to LAVI in predicting incident HF and death.
- LAEF provides valuable prognostic information in STEMI patients treated with primary PCI.
Objectives:
To assess the comparative effectiveness of left atrial (LA) functional parameters (left atrial emptying fraction (LAEF), left atrial expansion index (LAi) and minimal left atrial volume index (MinLAVI)) with that of LA volume index (LAVI) in predicting heart failure (HF) and death following ST-elevated myocardial infarction (STEMI).
Background:
HF is common following STEMI. Enlarged LA volume as determined by echocardiography predicts adverse outcome following STEMI. However, whether echocardiographic parameters of LA function, such as LAEF, LAi and MinLAVI, are superior to LAVI for predicting prognosis following STEMI is unknown.
Methods And Results:
A total of 369 patients with STEMI but without atrial fibrillation or HF who were treated with primary percutaneous coronary intervention were prospectively enrolled in the period between September 2006 and December 2008. Patients underwent echocardiography shortly after STEMI. The maximal and minimal LA volumes were measured using the biplane area-length method. LAVI, MinLAVI (minimal LA volume indexed to body surface area), LAEF ((maximal LA volume-minimal LA volume)/maximal LA volume), and LAi ((maximal LA volume-minimal LA volume)/minimal LA volume) were calculated. The endpoint was a composite consisting of HF or death from any cause. During a median follow-up of 66 months (interquartile range: 50-73 months), 112 patients reached the endpoint (68 HFs, 44 deaths). Following adjustment for clinical, biochemical and echocardiographic variables, only LAEF remained an independent predictor of the composite outcome, whereas LAVI did not (LAEF: HR 1.25, P = 0.043, per 1 SD decrease) (LAVI: HR 1.01, P = 0.91, per 1 SD increase).
Conclusion:
In patients with STEMI who were treated with primary percutaneous coronary intervention, LAEF, as measured by echocardiography shortly after infarction, was superior to LAVI in predicting incident HF and death.
