Cardiovascular magnetic resonance-derived left atrial function and left ventricular remodelling after reperfused anterior ST-elevation myocardial infarction

Introduction Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following reperfused ST-segment elevation myocardial infarction (STEMI). While both LV global longitudinal strain (GLS) and left atrial (LA) strain have independently demonstrated significant prognostic value for risk assessment in STEMI, the optimal atrial or ventricular functional parameter for risk assessment remains unclear. Purpose To investigate the prognostic significance of atrial and ventricular function indices, to predict early adverse LV remodelling in patients with anterior STEMI. Methods A post-hoc analysis of the European intracoronary cooling evaluation in ST-elevation myocardial infarction (EURO-ICE) trial was performed. In this study, patients with large anterior wall STEMI underwent cardiovascular magnetic resonance (CMR) at baseline (<1 week post-reperfused anterior STEMI) and at the 3-month follow-up. LV adverse remodelling was defined as an increase in LV end-diastolic volume of ≥20%. Left atrioventricular coupling index (LACI) was calculated as the ratio of left atrial end-diastolic volume to LV end-diastolic volume. Atrioventricular (AV) strain was calculated as the sum of LV global longitudinal strain (absolute values) and LA reservoir strain. The Mann-Whitney U test and logistic regression were used to identify differences and predictors of LV remodeling. Results In total, 188 patients were included. At baseline, LV end diastolic volume, LV GLS and LA reservoir strain, LACI, and AV strain were significantly different between patients with and without LV remodelling (table 1). Multivariate logistic regression showed that higher LACI was associated with adverse LV remodelling (p=0.005; table 2). Conclusions Although CMR-derived atrial and ventricular volume, as well as strain are significantly related to LV remodelling in patients with reperfused anterior STEMI, LACI is the strongest, independent predictor of adverse LV remodelling.