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dc.contributor.authorPrasad, SB
dc.contributor.authorGuppy-Coles, K
dc.contributor.authorStanton, T
dc.contributor.authorArmstrong, J
dc.contributor.authorKrishnaswamy, R
dc.contributor.authorWhalley, G
dc.contributor.authorAtherton, JJ
dc.contributor.authorThomas, L
dc.date.accessioned2020-02-07T01:06:53Z
dc.date.available2020-02-07T01:06:53Z
dc.date.issued2019
dc.identifier.issn0002-9149
dc.identifier.doi10.1016/j.amjcard.2019.05.007
dc.identifier.urihttp://hdl.handle.net/10072/391175
dc.description.abstractThe inter-relationships between minimal and maximal left atrial volume index (LAVI), left ventricular filling pressures and survival have not been well studied. This study aimed to compare LAVImin with LAVImax with respect to (1) relative prognostic value, and (2) correlation with left ventricular end-diastolic pressures (LVEDP), in patients with myocardial infarction (MI). A retrospective study involving consecutive patients with a first-ever MI (n = 419) was undertaken. LAVIs were determined using Simpson's biplane method from 2D echocardiography performed the day after admission. LAVmin ≥ 18 mls/m2 and LAVImax ≥ 34 mls/m2 were considered enlarged. The primary end point was composite major adverse cardiovascular events (MACE) (death/MI/heart failure). Correlation between LVEDP and LAVI was assessed in 120 patients who underwent echocardiography and cardiac catheterization either simultaneously (n = 30) or same-day (n = 90). At a median follow-up of 24 months, there were 61 MACE events. On Cox proportional hazards multivariate analysis incorporating significant clinical predictors and LVEF, whereas both LAVImin ≥ 18 mls/m2 (hazard ratio 3.15 [95% confidence interval 1.70 to 5.54], p <0.001) and LAVImax ≥ 34 mls/m2 (hazard ratio 1.79 [95% confidence interval 1.02 to 3.14], p = 0.041) were independent predictors of MACE, LAVImin showed a stronger association. Intermodel comparisons of the model chi-square and Harrell's C-statistic confirmed better prognostication with LAVImin. In the invasive cohort, because LAVImin and LAVImax had a similar correlation with LVEDP ≥ 15 mm Hg (r = 0.41 [p <0.001] vs r = 0.42 [p <0.001]), LAVmin ≥ 18 mls/m2 had a greater sensitivity for LVEDP ≥ 15 mm Hg than LAVImax ≥ 34 mls/m2 (sensitivity 59.4% vs 34.4%). In conclusion, utilizing thresholds of ≥18 and ≥34 mls/m2, respectively, LAVImin was a better predictor of survival than LAVImax, the pathophysiologic basis of which relates to a better sensitivity for elevated left ventricular filling pressures with LAVImin at these thresholds. There may be incremental clinical value in measuring LAVImin alongside LAVImax.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofpagefrom325
dc.relation.ispartofpageto333
dc.relation.ispartofissue3
dc.relation.ispartofjournalAmerican Journal of Cardiology
dc.relation.ispartofvolume124
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchcode3201
dc.titleRelation of Left Atrial Volumes in Patients With Myocardial Infarction to Left Ventricular Filling Pressures and Outcomes
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationPrasad, SB; Guppy-Coles, K; Stanton, T; Armstrong, J; Krishnaswamy, R; Whalley, G; Atherton, JJ; Thomas, L, Relation of Left Atrial Volumes in Patients With Myocardial Infarction to Left Ventricular Filling Pressures and Outcomes, American Journal of Cardiology, 2019, 124 (3), pp. 325-333
dcterms.dateAccepted2019-05-02
dc.date.updated2020-02-07T01:05:36Z
gro.hasfulltextNo Full Text
gro.griffith.authorStanton, Tony
gro.griffith.authorPrasad, Sandhir B.


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