In STEMI patients, left atrial fractional change assessed by CMR was independently associated with MACE (adjusted HR 0.66; 95% CI 0.46-0.95) and provided incremental prognostic value over LAmax.
Cohort (n=199)
Does LA fractional change measured by CMR predict MACE in patients following STEMI?
Impaired LA fractional change measured by CMR provides incremental prognostic information for MACE beyond established predictors including LA maximal volume in STEMI patients.
Effect estimate: adjusted HR 0.66 (95% CI 0.46-0.95)
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.
Lonborg et al. (Tue,) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=199). Left atrial (LA) fractional change assessment by CMR vs. LA maximal volume (LAmax) was evaluated on Major adverse cardiac event (MACE) including death, re-infarction, stroke, and admission for heart failure (adjusted HR 0.66, 95% CI 0.46-0.95). In STEMI patients, left atrial fractional change assessed by CMR was independently associated with MACE (adjusted HR 0.66; 95% CI 0.46-0.95) and provided incremental prognostic value over LAmax.
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