Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers Angers France.
Department of Cardiology University Hospital of Angers Angers France.
J Am Heart Assoc. 2023 Mar 21;12(6):e026048. doi: 10.1161/JAHA.122.026048. Epub 2023 Mar 16.
Background Following myocardial infarction, left ventricular remodeling (LVR) is associated with heart failure and cardiac death. At the same time, left atrial (LA) remodeling (LAR) is an essential part of the outcome of a wide spectrum of cardiac conditions. The authors sought to evaluate the correlates of LAR and its relationships with LVR after myocardial infarction. Methods and Results This is a retrospective analysis of 320 of 443 patients enrolled for study of LVR after ST-elevation myocardial infarction. Left ventricular (LV) volumes, infarct size and LA volume index were assessed by cardiac magnetic resonance imaging during index hospitalization (day 6 [interquartile range, 4-8]) and after a 3-month follow-up. LAR was studied using a linear mixed model for repeated measurements. Overall, there was a decrease in LA volume index between 6 days and 3 months (43.9±10.4 mL versus 42.8±11.1 mL, =0.003). Patients with changes in LA volume index >8% over time were older, with greater body mass index, lower LV ejection fraction, and larger infarct size. Unadjusted predictors of LAR were age older than 70 years, infarct size, anterior infarction, time to reperfusion, history of hypertension, LV end-diastolic volume, and heart failure at day 6. Independent correlates were age older than 70 years (3.24±1.33, =0.015) and infarct size (2.16±0.72 per 10% LV, <0.001). LA remodeling was correlated with LV remodeling (=0.372, <0.001), but neither LA nor LV volumes at day 6 were related to LVR or LAR, respectively. Conclusions The authors found LA changes to occur in the months after myocardial infarction, with an overall decrease in LA volumes. While LAR coincided with LVR, the correlates for LAR were age older than 70 years and larger infarct size.
心肌梗死后，左心室重构（LVR）与心力衰竭和心脏死亡相关。同时，左心房（LA）重构（LAR）是广泛心脏疾病结局的重要组成部分。作者试图评估 LAR 的相关性及其与心肌梗死后 LVR 的关系。
这是对 443 例接受 ST 段抬高型心肌梗死 LVR 研究的患者中的 320 例进行的回顾性分析。通过心脏磁共振成像在住院期间（第 6 天[四分位间距，4-8]）和 3 个月随访时评估 LV 容积、梗死面积和 LA 容积指数。使用重复测量线性混合模型研究 LAR。总体而言，LA 容积指数在 6 天至 3 个月之间下降（43.9±10.4 mL 比 42.8±11.1 mL，=0.003）。LA 容积指数随时间变化>8%的患者年龄较大，体重指数较高，LV 射血分数较低，梗死面积较大。LAR 的未调整预测因素为年龄>70 岁、梗死面积、前壁梗死、再灌注时间、高血压病史、LV 舒张末期容积和第 6 天心力衰竭。独立相关因素为年龄>70 岁（3.24±1.33，=0.015）和梗死面积（每 10%LV 增加 2.16±0.72，<0.001）。LA 重构与 LV 重构相关（=0.372，<0.001），但第 6 天的 LA 和 LV 容积均与 LVR 或 LAR 无关。
作者发现心肌梗死后数月内 LA 发生变化，LA 容积总体减少。虽然 LAR 与 LVR 同时发生，但 LAR 的相关因素为年龄>70 岁和梗死面积较大。
