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The role of left atrium in patient with myocardial infarction with ST-segment elevation (STEMI)

Session Poster session 1

Speaker Anna Giulia Pavon

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P158

Authors : A Pavon (Lausanne,CH), PG Masci (London,GB), A Bermano (Zurich,CH), A Vaxman (wien,AT), C Gotsman (new york,US), N Lauriers (Lausanne,CH), D Rodrigues (Lausanne,CH), P Monney (Lausanne,CH), T Rutz (Lausanne,CH), E Eeckhout (Lausanne,CH), O Muller (Lausanne,CH), J Schwitter (Lausanne,CH)

A Pavon1 , PG Masci2 , A Bermano3 , A Vaxman4 , C Gotsman5 , N Lauriers1 , D Rodrigues1 , P Monney1 , T Rutz1 , E Eeckhout1 , O Muller1 , J Schwitter1 , 1University Hospital Centre Vaudois (CHUV) - Lausanne - Switzerland , 2Kings College London, School of Bioengineer and Medical Sciences, Life Sciences, King’s College - London - United Kingdom of Great Britain & Northern Ireland , 3University of Zurich, Computer Graphics lab - Zurich - Switzerland , 4Geometric Modeling and Industrial Geometry group, Vienna University of Technology - wien - Austria , 5Jacobs Technion-Cornell Institute at Cornell Tech - new york - United States of America ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii114

Background: The left atrium (LA) is exposed to left ventricular (LV) pressure and volume changes. LA functional adaptation in acute ST-segment elevation myocardial infarction (STEMI) and during healing is not known.  Materials and Methods: We sought to examine LA changes in 31 patients with a first episode of STEMI. Patients underwent a cardiac magnetic resonance examination (CMR) on a 1.5 T system (Siemens Erlangen, Germany). 21 patients had a CMR within 15 days from STEMI (acute-STEMI), while 17 patients were studied after =40 days from the acute event (chronic-STEMI). 8 patients had 2 CMR examinations in both, the acute-STEMI and chronic-STEMI situation. For accurate LA function analyses, a compressed sensing (CS) cine pulse sequence was used (acquiring 3 short-axis and 2 long-axis 2D slices in a single breath-hold) and data were re-constructed in a 3D non model- based format (as previously published, Figure 1A, 1B). Active and passive LA emptying fraction (as % of pre-emptying LA volume) were calculated according the formula in Figure 1. Total indexed conduit LA volume is LA maximum – LA minimum volume (per body surface area). All data are presented as mean ± standard deviation. Results: Patients (n=31) were not known for previous cardiovascular events (age 65.9 ±14.5, 58% male) and all patients had primary percutaneous coronary intervention/stenting of the occluded coronary artery. Typical clinical characteristics were superimposable between the 2 groups. In 21 patients CMR was performed after 3.7±3.1 days from the acute event (=acute-STEMI). In 17 patients (chronic-STEMI) CMR was performed 75±34 days after the acute event. Active LA emptying fraction (%) decreased from the acute to the chronic state (43.3±18.9% vs 12.9±8.8% p=0.003), while passive LA emptying fraction (%) increased (9.0±4.9 vs 19.2±8.8%, p < 0.001; Figure 1C). Total indexed conduit LA volume was not different between the two populations (acute vs chronic: 25.0±8.1 vs 23.4±10.7ml/m2; p=ns). Among the 31 patients, 8 patients had CMR examinations at both time points (i.e. acute-STEMI and chronic-STEMI). Comparable changes were observed in these 8 patients (acute vs chronic LA active emptying fraction: 75.3±15.0 vs 43.0±24.2%, p=0.002; LA passive emptying fraction: 24.7±15.0 vs 57.2± 24.1%, p=0.008). Discussion: In the acute STEMI situation, the LA can adapt its active emptying performance in the presence of compromised passive emptying. This might reflect a compensatory mechanism to maintain adequate LV filling in the acute STEMI. This increased active LA emptying decreases in the chronic state after infarction. Further studies are warranted to confirm this preliminary data and to investigate the patho-physiological mechanisms promoting this LA adaptation.

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