Erik Jørgensen

Left atrial volume and function in patients following ST elevation myocardial infarction and the association with clinical outcome: a cardiovascular magnetic resonance study

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DOI

  • Jacob Thomsen Lønborg, Department of Cardiology, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Rigshospitalet, Denmark. Jacoblonborg@gmail.com
  • ,
  • Thomas Engstrøm
  • ,
  • Jacob Eifer Møller
  • ,
  • Kiril A Ahtarovski
  • ,
  • Henning Kelbæk
  • ,
  • Lene Holmvang
  • ,
  • Erik Jørgensen
  • Steffen Helqvist
  • ,
  • Kari Saunamäki
  • ,
  • Helle Søholm
  • ,
  • Mads Andersen
  • ,
  • Anders B Mathiasen
  • ,
  • Jørgen Tobias Kühl
  • ,
  • Peter Clemmensen
  • ,
  • Lars Køber
  • ,
  • Niels Vejlstrup

AIMS: The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is based almost exclusively on LA maximal volume (LAmax), which may not glean the full prognostic potential. Cardiovascular magnetic resonance (CMR) is considered the most accurate method for studying LA function and size. The aim of the present study was to evaluate the prognostic importance of LA function in patients following ST elevation myocardial infarction (STEMI).

METHODS AND RESULTS: In 199 patients, a CMR scan was performed within 1-3 days after STEMI to measure LAmax and minimal volume (LAmin) and LA function. The incidence of death, re-infarction, stroke, and admission for heart failure [major adverse cardiac event (MACE)] were registered during the follow-up period [2.3 years (inter-quartile range: 2.0-2.5)]. A total of 40 patients (20%) met the clinical endpoint of MACE during follow-up. In a Cox regression analysis adjusting for known risk factors, LA fractional change remained independently associated with MACE [adjusted hazard ratio: 0.66 (95% confidence interval: 0.46-0.95)]. LAmax, LAmin, or LA passive fraction was not independently associated with MACE. Furthermore, LA fractional change provided incremental prognostic value to LAmax and other known predictors (Wald χ(2) 31.0 vs. 39.9, P= 0.016).

CONCLUSION: In STEMI patients, impaired LA fractional change is independently associated with outcome and provide incremental prognostic information to established predictors including LAmax.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
Volume14
Issue2
Pages (from-to)118-27
Number of pages10
ISSN1525-2167
DOIs
Publication statusPublished - Feb 2013

    Research areas

  • Aged, Analysis of Variance, Atrial Function, Left, Electrocardiography, Female, Heart Function Tests, Humans, Linear Models, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardial Infarction, Organ Size, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Assessment, Severity of Illness Index, Stroke Volume, Survival Rate, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't

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