Meris Alessandra, Amigoni Maria, Uno Hajime, Thune Jens Jakob, Verma Anil, Køber Lars, Bourgoun Mikhail, McMurray John J, Velazquez Eric J, Maggioni Aldo P, Ghali Jalal, Arnold J Malcolm O, Zelenkofske Steven, Pfeffer Marc A, Solomon Scott D
Cardiovascular Division, Brigham and Women's Hospital, MA, USA.
Eur Heart J. 2009 Jan;30(1):56-65. doi: 10.1093/eurheartj/ehn499. Epub 2008 Nov 11.
To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up.
The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricular (LV) dysfunction, heart failure (HF), or both following MI. We assessed LA volume indexed to body surface area (LAVi) at baseline, 1 month, and 20 months after MI. Baseline LAVi was an independent predictor of all-cause death or HF hospitalization (P = 0.004). In patients who survived to 20 months, LAVi increased a mean of 3.00 +/- 7.08 mL/m(2) from baseline. Hypertension, lower estimated glomerular filtration rate, and LV mass were the only baseline independent predictors of LA remodelling. Changes in LA size were related to worsening in MR and increasing in LV volumes. LA enlargement during the first month was significantly greater in patients who subsequently died or were hospitalized for HF than in patients without events.
Baseline LA size is an independent predictor of death or HF hospitalization following high-risk MI. Moreover, LA remodelling during the first month after infarction is associated with adverse outcome.
评估高危心肌梗死（MI）后左心房（LA）大小与预后的关系，并研究长期随访期间LA大小的动态变化。
VALIANT超声心动图研究前瞻性纳入了610例MI后出现左心室（LV）功能障碍、心力衰竭（HF）或两者兼有的患者。我们在MI后基线、1个月和20个月时评估了体表面积校正的LA容积（LAVi）。基线LAVi是全因死亡或HF住院的独立预测因素（P = 0.004）。在存活至20个月的患者中，LAVi较基线平均增加3.00±7.08 mL/m²。高血压、较低的估计肾小球滤过率和LV质量是LA重塑的仅有的基线独立预测因素。LA大小的变化与二尖瓣反流恶化和LV容积增加有关。在随后死亡或因HF住院的患者中，第一个月的LA增大明显大于无事件发生的患者。
基线LA大小是高危MI后死亡或HF住院的独立预测因素。此外，梗死后第一个月的LA重塑与不良预后相关。
