Left atrial volume - A powerful predictor of survival after acute myocardial infarction
Left atrial volume - A powerful predictor of survival after acute myocardial infarction
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DOI：
10.1161/01.cir.0000066318.21784.43
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发表时间：
2003-05-06
期刊：
影响因子：
37.8
通讯作者：
Pellikka, PA
中科院分区：
文献类型：
--
作者：
Moller, JE;Hillis, GS;Pellikka, PA
背景 - 急性心肌梗死 (AMI) 后，通过多普勒超声心动图评估的舒张功能可提供重要的预后信息，该信息可增加收缩功能。然而，多普勒变量受多种因素影响，并且可能变化很快。相比之下，左心房 (LA) 体积受急性变化的影响较小，反映亚急性或慢性舒张功能。当评估 AMI 患者的风险时，这一点可能很重要。方法和结果 - 确定了 314 名 AMI 患者，他们在入院期间进行了经胸超声心动图评估左心室 (LV) 收缩和舒张功能并测量 LA 体积。根据体表面积对 LA 体积进行校正，并根据 LA 体积指数 32 mL/m(2)（高于正常值 2 个标准差）对群体进行划分。 142 例 (45%) 中 LA 体积指数 >32 mL/m(2)。主要研究终点是全因死亡率。在 15 个月（范围 0 至 33）个月的随访期间，46 名患者（15%）死亡。 LA 体积指数是死亡率的有力预测因子，并且在调整临床因素、左心室收缩功能和舒张功能的多普勒衍生参数后，仍然是一个独立的预测因子（每 1-mL/m(2) 变化，危险比为 1.05，95% CI 1.03 至 1.06，P < 0.001）。结论 - LA 体积指数增加是 AMI 后死亡率的有力预测因子，并提供预后信息 临床数据和左心室收缩和舒张功能的常规测量的增量。
Background - After acute myocardial infarction ( AMI), diastolic function assessed by Doppler echocardiography provides important prognostic information that is incremental to systolic function. However, Doppler variables are affected by multiple factors and may change rapidly. In contrast, left atrial ( LA) volume is less influenced by acute changes and reflects subacute or chronic diastolic function. This may be of importance when one assesses risk in patients with AMI.Methods and Results - Three hundred fourteen patients with AMI who had a transthoracic echocardiogram with assessment of left ventricular (LV) systolic and diastolic function and measurement of LA volume during admission were identified. The LA volume was corrected for body surface area, and the population was divided according to LA volume index of 32 mL/m(2) ( 2 SDs above normal). LA volume index was >32 mL/m(2) in 142 (45%). The primary study end point was all-cause mortality. During follow-up of 15 ( range 0 to 33) months, 46 patients (15%) died. LA volume index was a powerful predictor of mortality and remained an independent predictor ( hazard ratio 1.05 per 1- mL/m(2) change, 95% CI 1.03 to 1.06, P < 0.001) after adjustment for clinical factors, LV systolic function, and Doppler-derived parameters of diastolic function.Conclusions - Increased LA volume index is a powerful predictor of mortality after AMI and provides prognostic information incremental to clinical data and conventional measures of LV systolic and diastolic function.