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Left atrial function and mortality in patients with NSTEMI an MDCT study.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2011 Oct; Vol. 4 (10), pp. 1080-7. - Publication Year :
- 2011
-
Abstract
- Objectives: We sought to test the hypothesis that measures of left atrial (LA) function are independent predictors of mortality in patients with acute myocardial infarction.<br />Background: Left atrial maximal volume (LAmax) is known to predict mortality in patients with acute myocardial infarction. In a previous pilot study, however, we found that LA function in terms of fractional change and left atrial ejection fraction (LAEF) assessed by multidetector computed tomography (MDCT) is more closely related to clinical heart failure than LAmax.<br />Methods: We prospectively included 384 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent retrospectively gated, 64-slice MDCT coronary angiography and subsequent measurements of LA size and function. All patients were treated according to the current guidelines based on invasive coronary angiography. Patients were followed for a minimum of 2 years. The study endpoint was all-cause mortality.<br />Results: The median follow-up time was 36 months (range 10 to 1,551 days). During follow-up, 35 (9%) patients died. Overall, 1- and 2-year survival in the study cohort was 97% and 94%. LA size and mechanical function was obtained in all patients: mean LAmax was 55 ± 11 ml/m(2), LA minimal volume 31 ± 11 ml/m(2), fractional change 45 ± 9%, and LAEF 32 ± 9%. Using a Cox proportional hazards model with adjustments for age, number of diseased coronary vessels, left ventricular ejection fraction (LVEF), and Killip class, both fractional change (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.45 to 0.94) and LAEF (HR: 0.63; 95% CI: 0.44 to 0.91) remained independent predictors of mortality. In contrast to this, LAmax was not significantly associated with an increased risk of mortality in this population.<br />Conclusions: In a low-risk group of patients with NSTEMI, reduced LA function is an independent predictor of mortality and provides prognostic value incremental to that of LAmax.<br /> (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Chi-Square Distribution
Denmark
Female
Heart Atria diagnostic imaging
Heart Atria physiopathology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction physiopathology
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Regression Analysis
Risk Assessment
Risk Factors
Time Factors
Atrial Function, Left
Coronary Angiography methods
Myocardial Infarction diagnostic imaging
Myocardial Infarction mortality
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 4
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 21999867
- Full Text :
- https://doi.org/10.1016/j.jcmg.2011.08.008