| [Objective]:To study the value of left atrial volume index (LAVI) on prognosis of acute myocardial infarction (AMI).[Methods]:1. We retrospectively analyzed 172 patients with AMI who had a transthoracic echocardiogram with assessment of left ventricular (LV) systolic and diastolic function and measurement of LA volume during admission in the First Affiliated Hospital of Suzhou University from December 2008 to January 2010. The LA volume was corrected for body surface area, and the population was divided according to LA volume index of 32 mL/m2 (2 SDs above normal).we measured the EF, LVIDd, LVIDs, wall motion index, peak E, peak A, E/A, peak S, peak D, S/D, peak E deceleration time, left atrial diameter, LAV. The major adverse cardiovascular events(MACE) including recurrent myocardial infarction, new onset heart failure,intractable angina pectoris, and sudden cardiac death during hospitalization or from discharged to January 2011 are considered as the end point of the study.2.Take the Electrocardiogram on admission, take the history and physical examination in detail, complete the routine examination, recording age, sex, smoking history, hypertension, diabetes mellitus, admission heart rate, white blood cell count, total cholesterol, glyceroltriester, Killip classification and myocardial infarction location.3. According to the results of follow-up, all patients were divided into two groups: major adverse cardiovascular events group and without major adverse cardiovascular events group. We performed single factor analysis, then multivariate Logistic regression in the meaning factors to filter risk factors which influenced the prognosis. We followed up once per month until the end point event occured, totally 13 months and average of 7 months were observed.[Results]:1. There were totally 172 patients,88 cases in group A(LAVI>32ml /m2)and 84 cases in group B(LAVI<32ml/m2).Group A is higher than group B in age (74.18±6.49,62.92±10.50, P<0.001),hypertension disease rate (70.45%,50%, P=0.006),diabetes mellitus rate (65.91%,50%, P=0.034),heart rate(93.50±18.20, 76.05±15.20, P<0.001),killip classification≥Ⅱ(59.0%,17.86%, P<0.001), E/A(1.1±0.22, 0.97±0.17, P<0.001),LVIDd (52.92±1.84,49.14±3.64, P<0.001),LVIDs (37.49±4.07,33.93±2.3, P<0.001),peak D (0.53±0.06,0.51±0.09, P=0.01),LAD (69.89±7.17,42.53±4.21, P<0.001),LAV (51.66±4.99,42.42±5.62, P<0.001), and is lower in PCI(55%,100%, P<0.001),total cholesterol (4.12±1.49,4.67±0.90, P<0.001),EF (0.36±0.08,0.49±0.11, P<0.001),WMSI (1.51±0.16,1.63±0.12, P<0.001),S/D (1.00±0.15,1.08±0.20, P=0.002).The difference had significance.(2)During follow up of 7(range 0 to 13)months,60 major adverse cardiovascular events occured, including 15 recurrent myocardial infarction,3 intractable angina pectoris, 24 new onset heart failure and 18 cardiac death.47 MACE occured in group A(LAVI>32ml/m2), which included 13 recurrent myocardial infarction,2 intractable angina pectoris,17 new onset heart failure and 15 cardiac death. Univariate analysis showed that patients with hypertension disease (P=0.004),diabetes mellitus (P=0.045),larger LAVI (P<0.001),LAD (P<0.001),LAV (P<0.001),LVIDd (P<0.001),LVIDs (P=0.014),older age (P=0.003),rapid heart rate (P=0.009) and lower EF (P=0.004),WMSI (P<0.001),without PCI therapy (P<0.001),killip classification≥Ⅱ(P<0.001) is more likely to lead a poor prognosis.(3)Multivariate logistic regression analysis showed that increased LAVI(OR=1.193, 95%CI=1.094～1.3,P<0.001), killip classification≥Ⅱ(OR=2.371,95% CI=1.180-4.762,P<0.015)were associated with major adverse cardiovascular events during follow-up.(4)The Spearman correlation analysis showed that, there was weak correlation between LAVI and killip classification≥Ⅱ(r=0.213, P<0.005)[Conclusion] (1) Increased LA volume index and killip classification≥Ⅱwere powerful predictors of mortality after AMI.(2) There was weak correlation between LAVI and killip classification≥Ⅱ.(3) LAVI and killip classification≥Ⅱhad certain clinical value in risk stratification,therapy and evaluating the prognosis of AMI. |
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