Left atrial strain may predict LV remodeling in patients after acute myocardial infarction

Abstract

Background:Recently echocardiographic strain imaging has been proposed as a novel approach for the assessment of cardiac function after acute myocardial infarction (AMI Purpose: The aim of our study was to evaluate contraction of the left atrium (LA) using speckle tracking echocardiography (STE) technique in patients with AMI and to define the feasibility of this method in AMI patients with LV remodeling. Methods: A total of 136 patients (mean age 57.2+9.8) with a first AMI and 36 controls (mean age 60.8+10.2) were enrolled into the study. All of them underwent an echocardiographic investigation with STE for evaluation of LA strain. AMI patients were examined within 24-72 hours of the onset of AMI symptoms and in 4 months after AMI. 46 (33.8%) patients with LV remodeling were identified where LV remodeling was defined as a 15% increase from the baseline in LV end diastolic volume. Results: Conventional atrial measurements such as LA diameter, LA volume and LA volume index did not differ between the AMI patients and controls. LA peak systolic strain was markedly impaired in AMI patients (27.5+9.1% vs.36.7+6.5%, p,0.001). LA peak systolic strain was evaluated in AMI patients with LV remodeling and without LV remodeling. Both groups had comparable baseline clinical and echocardiographic characteristics, except for predominating anterior wall MI (p,0.01), higher leukocyte count value at admission (p,0.01), lower ejection fraction (p,0.05) and increased end systolic volume (p,0.05). LA peak systolic strain was lower in patients with LV remodeling if compare to non-LV remodeling patients (21.8+7.4% vs.29.5+8.8, p,0.05) while LA diameter and LA volume did not have significant differences between the two groups at the baseline. Logistic regression analysis showed that LV ejection fraction (O.R. 0.9; 95% CI 0.84-0.99, p,0.05) and atrial peak systolic strain (O.R.0.8; 95% CI 0.83-0.97, p,0.01) were independent determinants of LV remodeling after AMI. Conclusions: Our study demonstrates that STE is a promising non-invasive technique to assess LA atrial function in patients with AMI and may have an impact on LV remodeling prediction.