Korean Circ J.  2013 Nov;43(11):731-738. 10.4070/kcj.2013.43.11.731.

Progressive Dilation of the Left Atrium and Ventricle after Acute Myocardial Infarction Is Associated with High Mortality

• Yoon HJ
• Jeong MH
• Jeong Y
• Kim KH
• Song JE
• Cho JY
• Jang SY
• Jeong HC
• Lee KH
• Park KH
• Sim DS
• Yoon NS
• Hong YJ
• Park HW
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 2224804
• DOI: http://doi.org/10.4070/kcj.2013.43.11.731

Abstract

BACKGROUND AND OBJECTIVES
The purpose of this study is to identify the prevalence of progressive dilation in patients with acute myocardial infarction (AMI) combined with heart failure (HF) and determine the prognostic significance and associated factors with a geometric change of an infarcted heart.
SUBJECTS AND METHODS
A total of 1310 AMI patients with HF (63.9+/-12.5 years, 70% male) between November 2005 and April 2011 underwent echocardiography at admission and one year later. Left ventricular (LV) remodeling is defined as 20% progression, and left atria (LA) remodeling is 10% compared with the initial volume index.
RESULTS
The prevalence of both LA and LV remodeling was 13.9%; LV only was 9.3%, LA only 22.8% and non-remodeling was 55.1%, respectively. In the non-remodeling group, Killip class II was more frequent (83.9%, p<0.001) whereas in other remodeling groups, Killip class III was more frequent. Initial wall motion score index, ejection fraction, maximal cardiac enzyme, high sensitive C-reactive protein, B type natriuretic peptide, and triglyceride serum levels were significantly associated with heart remodeling. All causes of death occurred in 168 cases (12.8%) during the follow-up period. Mortality was the highest in the LV and LA remodeling group (20.9%) and the lowest in the non-remodeling group (11.4%). During the period of follow-up, the cumulative survival rate was significantly lower in the groups of LA and LV remodeling than in others (log rank p=0.006).
CONCLUSION
Total mortality was significantly increased in patients AMI with geometrically progressive LA and LV dilatation.

Keyword

Myocardial infarction; Ventricular remodeling; Heart failure; Prognosis

MeSH Terms

C-Reactive Protein
Cause of Death
Dilatation
Echocardiography
Follow-Up Studies
Heart
Heart Atria*
Heart Failure
Humans
Mortality*
Myocardial Infarction*
Prevalence
Prognosis
Survival Rate
Triglycerides
Ventricular Remodeling
C-Reactive Protein

Figure

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  Fig. 1 The prevalence of left ventricle (LV) and left atrium (LA) remodeling. Group I: LV and LA remodeling, Group II: LV remodeling, Group III: LA remodeling, Group IV: no remodeling.

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  Fig. 2 Mortality and major adverse cardiac events in four groups. Group I: LV and LA remodeling, Group II: LV remodeling, Group III: LA remodeling, Group IV: no remodeling. LV: left ventricle, LA: left atrium, MACE: major adverse cardiac event.

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  Fig. 3 Comparison of all-cause mortality and cardiac events. A: survival curve according to left ventricle (LV) and left atrium (LA) remodeling. B: major adverse cardiac events according to LV and LA remodeling. Group I: LV and LA remodeling; open red circle; ○, Group II: LV remodeling; open blue triangle; ▵, Group III: LA remodeling; open reverse green triangle; ▿, Group IV: no remodeling; open purple diamond; ⋄.

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