Tangen Jorun, Nguyen Thuy Mi, Melichova Daniela, Klaeboe Lars Gunnar, Forsa Marianne, Andresen Kristoffer, Wazzan Adrien Al, Lie Oyvind, Kizilaslan Fatih, Haugaa Kristina, Skulstad Helge, Brunvand Harald, Edvardsen Thor
ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet Sognsvannsveien 20, Nydalen, PO Box 4950, Oslo, NO-0424, Norway.
Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 9, Oslo, 0373, Norway.
Echo Res Pract. 2024 Oct 21;11(1):24. doi: 10.1186/s44156-024-00060-1.
The left atrial (LA) volume has been demonstrated to be an important predictor of adverse outcome in patients with various cardiac conditions, including acute myocardial infarction (AMI). However, new treatment strategies in patients with AMI have led to better patient outcomes. We hypothesised that increased LA size could still predict mortality in patients with AMI despite improved treatment strategies.
We included patients with AMI in a prospective multicenter cohort study and the study patients were enrolled from 2014 to 2022. We recorded echocardiographic and clinical data during their index hospitalisation. Indexed LA volume (LAVi) was assessed in all patients and was used as a continuous variable in the univariate and multivariate Cox regression analysis. The study took place over a period of five years and median follow-up time was 3.8 years (range 3.1 to 5.0 years). The primary study outcomes were all-cause mortality and major adverse cardiac events (MACE). MACE was defined as hospital readmission due to myocardial infarction, cardiac arrest, stroke, heart failure, or onset of new atrial fibrillation.
We included 487 patients (69 ± 12 years old, 26% female) with AMI. During the follow-up period all-cause mortality was 50 (10.3%) and patients who reached the primary outcomes were 153 (31.4%). The deceased patients had higher LAVi compared to survivors (40.0 ± 12.9 mL/m vs. 29.7 ± 11.2 mL/m, p < 0.001). Factors associated with all-cause mortality and MACE were age, year of enrollment, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), LV filling pressure, moderate or severe mitral regurgitation and LAVi. GLS and EF were segregated into two distinct models due to their moderately high correlation (r = 0.57, p < 0.001). LAVi remained as an independent echocardiographic predictor of primary outcomes after adjusting for the covariates above in two separates multivariable Cox regression models (hazard ratio 1.02/1.02 mL/m [95% CI 1.01-1.03/1.01-1.03], p = 0.006/0.003).
Our study demonstrated that LA dilatation is an independent echocardiographic predictor of mortality and MACE in patients with AMI despite improved treatment strategies. This finding highlights the potential of using LAVi as a marker for prognostication in these patients.
左心房（LA）容积已被证明是包括急性心肌梗死（AMI）在内的各种心脏疾病患者不良预后的重要预测指标。然而，AMI患者的新治疗策略已带来更好的患者预后。我们推测，尽管治疗策略有所改善，但LA增大仍可预测AMI患者的死亡率。
我们将AMI患者纳入一项前瞻性多中心队列研究，研究患者于2014年至2022年入组。我们记录了他们首次住院期间的超声心动图和临床数据。对所有患者评估了左心房容积指数（LAVi），并将其用作单变量和多变量Cox回归分析中的连续变量。该研究历时五年，中位随访时间为3.8年（范围3.1至5.0年）。主要研究结局为全因死亡率和主要不良心脏事件（MACE）。MACE定义为因心肌梗死、心脏骤停、中风、心力衰竭或新发心房颤动而再次住院。
我们纳入了487例AMI患者（69±12岁，26%为女性）。在随访期间，全因死亡率为50例（10.3%），达到主要结局的患者为153例（31.4%）。与幸存者相比，死亡患者的LAVi更高（40.0±12.9 mL/m²对29.7±11.2 mL/m²，p<0.001）。与全因死亡率和MACE相关的因素包括年龄、入组年份、左心室（LV）射血分数、LV整体纵向应变（GLS）、LV充盈压、中度或重度二尖瓣反流以及LAVi。由于GLS和EF的相关性中等偏高（r=0.57，p<0.001），因此将它们分为两个不同的模型。在两个单独的多变量Cox回归模型中，在对上述协变量进行调整后，LAVi仍然是主要结局的独立超声心动图预测指标（风险比1.02/1.02 mL/m²[95%CI 1.01 - 1.03/1.01 - 1.03]，p=0.006/0.003）。
我们的研究表明，尽管治疗策略有所改善，但LA扩张仍是AMI患者死亡率和MACE的独立超声心动图预测指标。这一发现突出了将LAVi用作这些患者预后评估指标的潜力。
