Left atrial parameters in the estimation of left ventricular filling pressure and prognosis in patients with acute coronary syndrome

Shih Hung Hsiao, Kuan Rau Chiou, Thomas R. Porter, Wei Chun Huang, Shih Kai Lin, Feng You Kuo, Chin Chang Cheng, Ko Long Lin, Shoa Lin Lin

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Because left atrial (LA) volume plays a critical role in determining cardiovascular outcomes, it was hypothesized that this might be related to the distensibility of the left atrium and how this relates to left ventricular filling pressure (LVFP). Echocardiographic estimates of LVFP were compared to cardiac catheterization measurements in 521 consecutive patients with acute myocardial infarction and correlated with short- and long-term outcomes. Receiver-operating characteristic curve analysis was performed to investigate the sensitivity and specificity of echocardiographic parameters for predicting elevated LVFP (>15 mm Hg). LA distensibility was calculated as (maximal volume - minimal volume) × 100%/minimal volume. and was found to be logarithmically associated with LVFP (p <0.0001). LA distensibility was superior to mitral E/annular Em for identifying increased LVFP (area under the receiver-operating characteristic curve 0.92 vs 0.78). A total of 44 patients died during hospitalization, and 89 patients had died or experienced heart failure requiring rehospitalization at 12-month follow-up. In a multivariate Cox regression model, LA distensibility was an independent predictor of in-hospital mortality (hazard ratio 2.373 for LA distensibility ≤60%, p = 0.026), while LA volume was an independent prognostic factor of 1-year death or heart failure (hazard ratio 2.266 for LA volume <34 ml/m2, p = 0.007). In conclusion, LA distensibility accurately identifies patients with increased LVFP after acute myocardial infarction and is an independent predictor of in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)1117-1124
Number of pages8
JournalAmerican Journal of Cardiology
Volume107
Issue number8
DOIs
StatePublished - Apr 15 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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