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Left atrial enlargement is a predictor of heart failure and cardiovascular events after acute coronary syndromes

Session Poster session 3

Speaker Sofia Cardoso Torres

Congress : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Imaging: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P964

Authors : S Cardoso Torres (Porto,PT), C Resende (Porto,PT), P Maia Araujo (Porto,PT), A Nunes (Porto,PT), S Maia (Porto,PT), C Sousa (Porto,PT), MJ Maciel (Porto,PT), F Macedo (Porto,PT)

Authors:
S Cardoso Torres1 , C Resende1 , P Maia Araujo1 , A Nunes1 , S Maia1 , C Sousa1 , MJ Maciel1 , F Macedo1 , 1Sao Joao Hospital - Porto - Portugal ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i688

Introduction: Echocardiography remains a central tool in prognosis prediction after an acute coronary syndrome. Left ventricular ejection fraction is an established parameter for risk stratification of this group of patients. On the other hand, there is limited data about the impact of diastolic disfunction echocardiographic parameters in the prognosis of this population.

Purpose:  To evaluate echocardiographic parameters of diastolic disfunction as predictors of major cardiovascular events in patients with ACS during a 2-year follow-up.

Methods: We retrospectively evaluated 92 consecutive pts admitted to our center due to ACS, with a mean follow up of 2 years. Echocardiographic parameters of diastolic function (performed during the first 48h after admission) and clinical data were evaluated. Left atrial (LA) enlargement (LAE) was defined as a body surface area indexed LA volume (LAVi) > 34 ml/m2.  MACCE was defined as the composite of death, ACS, stroke, repeat revascularization (RR) and congestive heart failure requiring hospitalization (CHF) after hospital discharge.

Results: A total of 92 pts with a mean age of 64.6±12.3 years, of whom 73.9% were male, were included in our study. At the end of follow-up, 44.9% of pts were at NYHA class = II. These pts had significantly higher LAVi (35.60 vs 29.46 ml/m2; p=0.040), and on univariate analysis LAE was the only significant predictor of this outcome (OR 4.22; 95% CI 1.67-10.66; p=0.002), while other classic echocardiographic parameters of diastolic function were not (E wave; A wave; e’ wave; E/A ratio or E/e’ ratio).
During follow-up MACCE occurred in 18 pts (19.6%): death in 6 (6.5%), ACS in 7 (7.6%), RR in 5 (5.4%) and CHF in 4 (4.3%). LAE was associated with a significantly higher risk for MACCE (29.3% vs 6.7%; p=0.006; OR 5.79) and on univariate analysis it was a significant predictor of these events (OR 5.79.; 95% CI 1.50-22.36; p=0.011), with an area under the ROC curve of 0.70 (95% CI 0.56-0.84; p=0.018).

Conclusions: In our study, left atrial enlargement was the only diastolic echocardiographic parameter which predicted cardiovascular events and heart failure development in ACS patients. While the other diastolic function parameters can be more variable depending on hemodynamic status, left atrial size reflects a continuous relation with chronic cardiac loading conditions, which may be an explanation for our findings.



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