Abstract 13028: Left Atrial Strain Predicts Adverse Events in Patients after Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
Background: Left atrial (LA) maximal volume has been recognized as a powerful predictor of mortality and hospitalization for heart failure in patients after acute myocardial infarction (AMI). Besides LA volume, LA mechanical function and LA strain have been identified as measurements to quantify LA performance with 2-dimensional (2D) echocardiography. The purpose of the study was to investigate the association between LA performance expressed in LA volumes, mechanical function and strain, and adverse events in patients after AMI treated with primary percutaneous coronary intervention.
Methods: Consecutive patients admitted with AMI treated with primary percutaneous coronary intervention (PCI) were evaluated. All patients were treated according to the institutional AMI protocol, which includes 2D echocardiography within 48 hours of admission and follow-up at the outpatient clinic for at least 1 year.
Results: A total of 320 patients (mean age: 60 ± 12 years, 78% men) were followed for 27 ± 14 months. During follow-up 29 patients died (9%), 11 patients (3%) had a nonfatal reinfarction and 14 patients (4%) were hospitalized for heart failure. Mean LA maximal volume was 25 ± 7 ml/m2. Mean LA strain and strain rate were 33 ± 11% and 2.3 ± 0.7 s−1, respectively. In addition to clinical characteristics and echocardiographic measurements of LV function, LA function significantly predicted worse outcome. LA maximal volume, LA ejection fraction, LA strain and strain rate were univariable predictors of the composite endpoint. After adjustment for a broad range of clinical and echocardiographic parameters, LA maximal volume (HR 1.05, CI 1.00 – 1.10, p <0.05) and LA strain (HR 0.94, CI 0.89 – 0.99, p <0.05) independently predicted adverse outcome. In addition, LA strain provided incremental value to LA maximal volume (p <0.05) for the prediction of adverse outcome.
Conclusions: In patients after AMI treated with primary percutaneous coronary intervention, LA function provides important prognostic value. In addition to LA maximal volume, LA strain is a promising novel technique to quantify LA performance.
- © 2010 by American Heart Association, Inc.