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Prognostic value of left atrial volume index in acute coronary syndrome: A systematic review and meta-analysis
Artan Ahmeti1,2, Feriz S Bytyçi3, Agata Bielecka-Dabrowa4
1Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
Insights
Increased left atrial volume (LAV) predicts worse outcomes in acute coronary syndrome (ACS) patients. Measuring LAV index (LAVI) aids risk stratification and guides optimal clinical management for better patient outcomes.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Increased left atrial volume (LAV) signifies diastolic dysfunction and elevated left ventricle pressure in patients without mitral valve disease.
- The study investigates the predictive value of baseline LAV in patients experiencing acute coronary syndrome (ACS).
Purpose of the Study:
- To evaluate the role of increased baseline left atrial volume (LAV) in predicting clinical outcomes for patients with acute coronary syndrome (ACS).
Main Methods:
- A systematic search of electronic databases up to September 2020 identified clinical trials and observational studies.
- The meta-analysis included 2,705 patients from 11 cohort studies with a mean follow-up of 18.7 months.
- Primary endpoints included major adverse cardiac events (MACE), all-cause mortality, and hospitalization; secondary endpoints were in-hospital complications.
Main Results:
- Patients with low left atrial volume index (LAVI) demonstrated significantly lower risks of MACE (15.9% vs. 33.7%), long-term mortality (9.14% vs. 18.1%), and hospitalization (11.6% vs. 25.5%) compared to those with increased LAVI.
- In-hospital events such as atrial fibrillation and cardiogenic shock were less frequent in patients with low LAVI.
- No significant difference in ventricular fibrillation/tachycardia was observed between groups.
Conclusions:
- Elevated left atrial volume index (LAVI) is an independent predictor of adverse outcomes in patients with acute coronary syndrome (ACS).
- Assessing LAVI is crucial for accurate risk stratification and optimizing clinical management in ACS patients.
Background:
In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long-standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS).
Methods:
We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all-cause mortality and hospitalization. Secondary endpoints were in-hospital complications.
Results:
A total of 2,705 patients from 11 cohort studies with a mean follow-up 18.7 ± 9.8 months were included in the meta-analysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long-term all-cause mortality (9.14% vs. 18.1%; p < .01), short-term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in-hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14).
Conclusion:
Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.
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