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European Heart Journal Advance Access published online on November 11, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn499
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALIANT Echo Study

Alessandra Meris1, Maria Amigoni1, Hajime Uno2, Jens Jakob Thune1, Anil Verma1, Lars Køber3, Mikhail Bourgoun1, John J. McMurray4, Eric J. Velazquez5, Aldo P. Maggioni6, Jalal Ghali7, J. Malcolm O. Arnold8, Steven Zelenkofske9, Marc A. Pfeffer1 and Scott D. Solomon1,*

1 Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, MA, USA
2 Harvard School of Public Health, Boston, MA, USA
3 University of Copenhagen Rigshospitalet, Copenhagen, Denmark
4 Western Infirmary, Glasgow, Scotland
5 Duke University Medical Center, Durham, NC, USA
6 ANMCO Research Center, Florence, Italy
7 Cardiac Centers of Louisiana, Shreveport, LA, USA
8 London Health Sciences Center-Victoria Campus, East London, Canada
9 Novartis Pharmaceuticals, East Hanover, NJ, USA

Received 16 March 2008; revised 14 October 2008; accepted 16 October 2008.

* Corresponding author. Tel: +1 617 732 7182, Fax: +1 617 277 4981, Email: ssolomon{at}rics.bwh.harvard.edu

Aims: To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up.

Methods and results: The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricular (LV) dysfunction, heart failure (HF), or both following MI. We assessed LA volume indexed to body surface area (LAVi) at baseline, 1 month, and 20 months after MI. Baseline LAVi was an independent predictor of all-cause death or HF hospitalization (P = 0.004). In patients who survived to 20 months, LAVi increased a mean of 3.00 ± 7.08 mL/m2 from baseline. Hypertension, lower estimated glomerular filtration rate, and LV mass were the only baseline independent predictors of LA remodelling. Changes in LA size were related to worsening in MR and increasing in LV volumes. LA enlargement during the first month was significantly greater in patients who subsequently died or were hospitalized for HF than in patients without events.

Conclusion: Baseline LA size is an independent predictor of death or HF hospitalization following high-risk MI. Moreover, LA remodelling during the first month after infarction is associated with adverse outcome.

Key Words: Echocardiography • Left atrial remodelling • Myocardial infarction • Prognosis


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Left atrium remodelling after acute myocardial infarction: different in different risk categories
Bogdan A. Popescu, et al.
European Heart Journal, 3 Nov 2009 [Full text]

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