Abstract 11018: Left Atrial Volume Index (LAVI) over Late Diastolic Mitral Annular Velocity (a') is a Powerful Predictor of Cardiac Death and Heart Failure in Patients with a First ST Elevation Acute Myocardial Infarction
Background: Increased left atrial volume index (LAVI) is a powerful predictor of mortality after acute myocardial infarction (AMI). Recently, the late diastolic mitral annular velocity (a'), which is considered to reflect atrial pump function, has been reported as a useful index of pulmonary congestion among the patients with LV dysfunction. The aim of this study was to investigate whether the ratio of LAVI/a' is a useful index in predicting the prognosis of patients following a first ST elevation AMI (STEMI).
Methods: One hundred fifty-one consecutive patients with a first STEMI (age=62±9 y.o., male=121) were enrolled in the study. All patients successfully underwent reperfusion therapy by PCI within 12 hours of STEMI onset. Echocardiography was performed 2 weeks later, and patients were followed up for 36 months. The primary end points were cardiac death and readmission because of heart failure. Exclusion criteria were non-STEMI, A-C bypass, atrial fibrillation and renal failure on dialysis.
Results: The primary endpoints occurred in 12 patients within 36 months (cardiac death; 4 patients, CHF; 8 patients). Table presents the results of univariate and multivariate analysis using the lowest quartile value. Univariate analysis showed that an E/e'>14.5, EF<48%, and LAVI/a'>4.4 were independent predictors of the primary end points. Multiple logistic regression analysis revealed that LAVI/a'>4.4 was the strongest predictor of the primary end points within 36 months.
Conclusions: LAVI/a' was the strongest predictor of CHF and cardiac death within 36 months of a first STEMI onset. Despite successful administration of reperfusion therapy, the higher the LAVI/a' (>4.4) after 2weeks of onset, the greater the LV damage caused by STEMI. Furthermore, LAVI/a' was superior to E/e' to predict the prognosis in patients with a first STEMI.
- © 2010 by American Heart Association, Inc.