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Association of left atrial enlargement with heart failure and cardiovascular events after acute coronary syndromes

Session Poster Session 3

Speaker Paulo Maia Araujo

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : PM Araujo (Porto,PT), S Torres (Porto,PT), C Resende (Porto,PT), A Nunes (Porto,PT), C Sousa (Porto,PT), M Campelo (Porto,PT), F Macedo (Porto,PT), MJ Maciel (Porto,PT)

Authors:
PM Araujo1 , S Torres1 , C Resende1 , A Nunes1 , C Sousa1 , M Campelo1 , F Macedo1 , MJ Maciel1 , 1Sao Joao Hospital, Cardiology - Porto - Portugal ,

Citation:

Introduction:  Acute coronary syndromes (ACS) are associated with significant morbidity and mortality not only during the acute phase, but also after the event. The occurrence of new major adverse cardiac and cerebrovascular events (MACCE) and heart failure (HF) during follow-up is difficult to predict.

Purpose:  Evaluate if the presence of left atrial (LA) enlargement (LAE) in the acute phase of ACS was associated with MACCE and/or HF during follow-up.

Methods: Retrospective evaluation of 92 consecutive pts admitted to our center due to ACS, with a follow up of 2 years. Echocardiographic parameters of diastolic function (performed during the first 48h after admission) and clinical data were evaluated. LAE was defined as a body surface area indexed LA volume (ILAV) > 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: Mean age was 64.6±12.3 years, with a male predominance (73.9%). At the end of follow-up, 44.9% of pts were at NYHA class = 2. These pts had significantly higher ILAV (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 (peak E, A and e’ wave velocities; E/A and E/e’ ratios). 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 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:  The detection of LAE during the acute phase of ACS was a significant predictor of MACCE and HF during the follow-up, while other parameters of diastolic function weren’t capable to do so.

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