Sakaguchi Eirin, Yamada Akira, Sugimoto Kunihiko, Ito Yoshihiro, Shiino Kenji, Takada Kayoko, Iwase Masatsugu, Ozaki Yukio
Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
Eur J Echocardiogr. 2011 Jun;12(6):440-4. doi: 10.1093/ejechocard/jer058. Epub 2011 May 17.
We evaluated the usefulness of left atrial volume index (LAVI) and the degree of changes in LAVI (delta LAVI) during hospitalization for the prediction of prognosis after acute myocardial infarction (AMI).
We investigated 205 consecutive patients with first AMI. They underwent echocardiography on admission as well as at discharge. Delta LAVI was calculated by subtracting the value on admission from that at discharge. The primary endpoints were major cardiac events (MACE): cardiac death due to heart failure and heart failure hospitalization. During a mean follow-up of 26 months, MACE occurred in 29 patients. Patients were divided into two groups according to the optimal cut-off values of LAVI (32.0 mL/m(2)) at discharge and delta LAVI (2.5 mL/m(2)) derived from receiver operating characteristic curves, respectively; Group I: LAVI ≤ 32.0 mL/m(2), Group II: LAVI > 32.0 mL/m(2) and Group A: delta LAVI ≤ 2.5 mL/m(2), Group B: delta LAVI > 2.5 mL/m(2). In comparisons of two groups, respectively, the incidence of MACE between the groups showed significant differences [Group I (3.8%) vs. Group II (32.0%): P < 0.001, log-rank, Group A (7.4%) vs. Group B (20.0%): P = 0.0079, log-rank]. In multivariate analysis, LAVI at discharge [risk ratio (RR): 1.077, 95% CI: 1.035-1.124, P = 0.0002] and delta LAVI (RR: 1.056, 95% CI: 1.012-1.108, P = 0.0109) were significant. LAVI > 32.0 mL/m(2) at discharge (sensitivity: 93%, specificity: 69%) and delta LAVI > 2.5 mL/m(2) (sensitivity: 79%, specificity: 50%) were predictors of MACE.
LAVI at discharge and delta LAVI would be useful predictors for MACE after first AMI.
我们评估了急性心肌梗死（AMI）住院期间左心房容积指数（LAVI）及其变化程度（ΔLAVI）对预测预后的有用性。
我们调查了205例连续的首次发生AMI的患者。他们在入院时及出院时均接受了超声心动图检查。ΔLAVI通过出院时的值减去入院时的值来计算。主要终点是主要心脏事件（MACE）：因心力衰竭导致的心脏死亡和心力衰竭住院。在平均26个月的随访期间，29例患者发生了MACE。根据出院时LAVI（32.0 mL/m²）和从受试者工作特征曲线得出的ΔLAVI（2.5 mL/m²）的最佳截断值，将患者分为两组；第一组：LAVI≤32.0 mL/m²，第二组：LAVI>32.0 mL/m²，A组：ΔLAVI≤2.5 mL/m²，B组：ΔLAVI>2.5 mL/m²。在两组比较中，两组间MACE的发生率显示出显著差异[第一组（3.8%）对第二组（32.0%）：P<0.001，对数秩检验，A组（7.4%）对B组（20.0%）：P = 0.0079，对数秩检验]。在多变量分析中，出院时的LAVI[风险比（RR）：1.077，95%置信区间：1.035 - 1.124，P = 0.0002]和ΔLAVI（RR：1.056，95%置信区间：1.012 - 1.108，P = 0.0109）具有显著性。出院时LAVI>32.0 mL/m²（敏感性：93%，特异性：69%）和ΔLAVI>2.5 mL/m²（敏感性：79%，特异性：50%）是MACE的预测指标。
出院时的LAVI和ΔLAVI是首次发生AMI后MACE的有用预测指标。
