Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction

Impact of left atrial diameter on all-cause mortality of patients with STEMI undergoing primary percutaneous coronary intervention

OBJECTIVES

To evaluating the predictive significance of the left atrial diameter in acute ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).

METHODS

The STEMI population came from 2 retrospective cohorts with 1097 patients, cohorts A (YongChuan Hospital) and cohorts B (Taizhou First People's Hospital). Within 3 days (cohort A) or 5 days (cohort B) post-PCI, patients underwent ultrasound evaluations. Cohort A was segmented into quartile categories based on eft atrial diameter (LAd) (Q1 to Q4). The odds ratios (ORs) for overall mortality were assessed using logistic regression. Cohort B was used for sensitivity analysis.

RESULTS

During follow-up period, 226 (20.6%) patients experienced endpoint. In cohort A, univariable odds ratios were 2.68 (95%CI 1.11~6.89), 5.32 (95%CI 2.46~12.83) and 11.92 (95%CI 5.78~27.92), while multivariate ORs were 2.25 (95%CI 0.82~6.55), 5.09 (95%CI 2.12~13.56), and 15.05 (95%CI 6.58~39.09) in Q2 to Q4 group, respectively, compared with Q1 group (p for trend <0.001). Upon subgroup evaluation, the correlation between LAd and the likelihood of overall mortality was more pronounced in patients having a left ventricular ejection fraction (LVEF) between 40% and 50%, and those with LVEF ≥50%, in contrast to those with LVEF <40% (p for interaction <0.001).

CONCLUSION

Left atrial diameter is indicative of the long-term overall mortality risk in STEMI patients post-PCI, particularly in those with an LVEF ≥ 40%.

Tissue Doppler-derived atrial dyssynchrony predicts new-onset atrial fibrillation during hospitalization for ST-elevation myocardial infarction

BACKGROUND

Atrial dyssynchrony, but not atrial enlargement/dysfunction, reflects acute atrial histopathological changes. It has been shown to be associated with new-onset atrial fibrillation (NOAF) in various clinical conditions but was not studied in the acute phase of ST-elevation myocardial infarction (STEMI) which is the aim of the current study.

METHODS

A total of 440 STEMI patients underwent primary percutaneous coronary intervention (PCI) and were monitored for NOAF during hospitalization. Immediately after primary PCI, P-wave dispersion was calculated and conventional/tissue Doppler echocardiography was done.

RESULTS

During a median hospitalization period of 3 days, 80 (18.2%) patients developed NOAF. The group with NOAF showed significantly higher prevalence of hypertension (P = .049), higher P-wave dispersion (P = .018), higher post-PCI-corrected TIMI frame count (P < .001), and lower incidence of post-PCI myocardial blush grade 2-3 (P = .031). Indexed left atrial maximum volume (LAVI_max ), left atrial dyssynchrony, and inter-atrial dyssynchrony were significantly higher in NOAF group (P < .001, each). Using ROC curve analysis, inter-atrial dyssynchrony showed the highest diagnostic performance (AUC 85%, 95% CI: 0.77-0.94, P < .001). A cutoff value at 23.8 ms showed a good validity for predicting NOAF with a sensitivity of 93.8% and a specificity of 68.1%. Using binary logistic regression analysis, history of hypertension (OR = 10.72, P = .03), LAVI_max (OR = 7.47, P = .04), and inter-atrial dyssynchrony (OR = 45.58, P = .001) were independent determinants of NOAF.

CONCLUSIONS

In the acute phase after STEMI, history of hypertension, LAVI_max, and inter-atrial dyssynchrony were independent determinants of inhospital NOAF, with the latter being the strongest.