Prognostic Markers in Acute MI ong-Term Prognostic Significance of eft Atrial Volume in Acute Myocardial Infarction

OBJECTIVES The aim of this study was to evaluate the significance of increased left atrial (LA) volume determined within the first 48 h of admission as a long-term predictor of outcome in patients with acute myocardial infarction (MI). BACKGROUND The LA volume reflects left ventricular (LV) diastolic properties. Whereas other LV Doppler diastolic characteristics are influenced by acute changes in LV function, LA volume is stable and reflects diastolic properties before MI. METHODS Clinical and echocardiographic parameters were prospectively collected in 395 consecutive patients with acute MI. Patients with LA volume index (LAVI) 32 ml/m (normal 2 standard deviations) were compared with those with LAVI 32 ml/m. Independent clinical and echocardiographic prognostic risk factors for five years’ mortality were determined by the Cox proportional hazard model. RESULTS Left atrial volume index 32 ml/m was found in 63 patients (19%) who had a higher incidence of congestive heart failure on admission (24% vs. 12%, p 0.01), a higher incidence of mitral regurgitation, increased LV dimensions, and reduced LV ejection fraction when compared with patients with LAVI 32 ml/m. Their five-year mortality rate was 34.5% versus 14.2% (p 0.001). Significant independent risk predictors of five years’ mortality were age (10 years) (odds ratio [OR] 1.45; 95% confidence interval [CI]1.14 to 1.86), Killip class 2 on admission (OR 2.30; 95% CI 1.29 to 4.09), LAVI 32 ml/m (OR 2.22; 95% CI 1.25 to 3.96), diabetes (OR 1.94; 95% CI 1.15 to 3.28), and LV restrictive filling pattern (OR 1.89; 95% CI 1.09 to 3.31). CONCLUSIONS In patients with acute MI, increased LA volume, determined within the first 48 h of admission, is an independent predictor of five-year mortality with incremental prognostic information to clinical and echocardiographic data. (J Am Coll Cardiol 2004;44:327–34) © 2004 by the American College of Cardiology Foundation