Left atrial strain may help predict adverse events in AMI patients
MedWire News: Left atrial (LA) strain has prognostic value in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI), research from The Netherlands suggests.
Victoria Delgado and colleagues (Leiden University Medical Center) report that patients with elevated LA strain are at increased risk for adverse outcomes.
The team studied the echocardiographic data of 320 consecutive AMI patients treated with PCI. They then compared this against 35 controls selected from an echocardiographic database who were matched for age and gender, and had no structural heart disease.
The researchers quantified LA volume and LA performance (mechanical function and systolic strain), with normal reference values of LA phasic volumes, strain and strain rate provided by the controls. The endpoint of the study was the composite outcome of all-cause mortality, nonfatal reinfarction, and hospitalization for heart failure (HF). The mean age of the patients was 60 years and 78% were male.
The findings, published in the journal Heart, revealed that 15% of patients reached the composite outcome during the follow-up period of 27 months. After adjusting for clinical and echocardiographic parameters, LA maximal volume and LA strain were independent predictors of this endpoint (p=0.04 and p=0.02, respectively).
The researchers dichotomized LA maximal volume and LA strain according to normal and abnormal LA function using cut-off values of 32 ml/m2 and 19%, respectively, to investigate the prognostic value of LA function further. Kaplan-Meier analysis showed that there was a 26% incidence of adverse events at 3 years in the 23 patients with LA strain <19%, compared with a 12% incidence rate in the 228 patients with LA strain ≥19% (p=0.001).
Crucially, they found that LA strain provided incremental value to LA maximal volume for the prediction of adverse outcomes (p=0.03).
Delgado et al believe their findings provide "useful information" for AMI patients treated with PCI.
"LA strain is a promising novel technique to quantify LA function; it provides additional value to baseline risk factors and LA maximal volume for the prediction of adverse effects after AMI," they conclude.
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By Piriya Mahendra