TY - JOUR

T1 - Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise

AU - Bakkestrøm, Rine

AU - Andersen, Mads J

AU - Ersbøll, Mads

AU - Bro-Jeppesen, John

AU - Gustafsson, Finn

AU - Køber, Lars

AU - Hassager, Christian

AU - Møller, Jacob E

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/11/15

Y1 - 2016/11/15

N2 - BACKGROUND: Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides.METHODS: 62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m(2) within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test.RESULTS: LA remodeling was considered in patients with a change from mild (35-41ml/m(2)), to severe (>48ml/m(2)) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred.CONCLUSION: Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.

AB - BACKGROUND: Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides.METHODS: 62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m(2) within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test.RESULTS: LA remodeling was considered in patients with a change from mild (35-41ml/m(2)), to severe (>48ml/m(2)) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred.CONCLUSION: Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.

KW - Journal Article

U2 - 10.1016/j.ijcard.2016.08.228

DO - 10.1016/j.ijcard.2016.08.228

M3 - Journal article

C2 - 27573595

VL - 223

SP - 717

EP - 722

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -