Relationship of ischemic times and left atrial volume and function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

  • Ivan Ilic
  • Ivan Stankovic
  • Radosav Vidakovic
  • Vladimir Jovanovic
  • Alja Vlahovic Stipac
  • BIljana Putnikovic
  • Aleksandar N. Neskovic
Original Paper


Little is known about the impact of duration of ischemia on left atrial (LA) volumes and function during acute phase of myocardial infarction. We investigated the relationship of ischemic times, echocardiographic indices of diastolic function and LA volumes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). A total of 433 consecutive STEMI patients underwent echocardiographic examination within 48 h of primary PCI, including the measurement of LA volumes and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e′). Time intervals from onset of chest pain to hospital admission and reperfusion were collected and magnitude of Troponin I release was used to assess infarct size. Patients with LA volume index (LAVI) ≥28 ml/m2 had longer total ischemic time (410 ± 347 vs. 303 ± 314 min, p = 0.007) and higher E/e′ ratio (15 ± 5 vs. 10 ± 3, p < 0.001) than those with LAVI <28 ml/m2, while the indices of LA function were similar between the study groups (p > 0.05, for all). Significant correlation was found between E/e′ and LA volumes at all stages of LA filling and contraction (r = 0.363–0.434; p < 0.001, for all) while total ischemic time along with E/e′ and restrictive filling pattern remained independent predictor of LA enlargement. Increased LA volume is associated with longer ischemic times and may be a sensitive marker of increased left ventricular filling pressures in STEMI patients treated with primary PCI.


Left atrial volume Ischemic time Diastolic dysfunction Myocardial infarction 



Hospital admission


Body mass index


Body surface area


Coronary artery bypass grafting


Coronary artery disease


Confidence interval


Cerebrovascular accident




Ejection fraction


Left atrium


Left anterior descending


Left atrial ejection fraction


Left atrial volume index


Left ventricle


Left ventricular end diastolic pressure


Myocardial infarction


Odds ratio


Peripheral arterial disease


Percutaneous coronary intervention


Right coronary artery


Restrictive filling pattern


ST-segment elevation myocardial infarction


Stroke volume


Thrombolysis in myocardial infarction



Drs. Putnikovic and Neskovic are partly supported by Grant No. 175099 of the Ministry of Science, Republic of Serbia. Unrestricted software support was provided by GE Healthcare.

Conflict of interest

Other authors have no conflict of interest to declare regarding this manuscript.


  1. 1.
    Stefanadis C, Dernellis J, Toutouzas P (2001) A clinic appraisal of left atrial function. Eur Heart J 22:22–36CrossRefPubMedGoogle Scholar
  2. 2.
    Hoit BD, Gabel M (2000) Influence of left ventricular dysfunction on the role of atrial contraction. J Am Coll Cardiol 36:1713–1719CrossRefPubMedGoogle Scholar
  3. 3.
    Popovic AD, Neskovic AN, Marinkovic J, Lee JC, Tan M, Thomas JD (1996) Serial assessment of left ventricular chamber stiffness after acute myocardial infarction. Am J Cardiol 77:361–364CrossRefPubMedGoogle Scholar
  4. 4.
    Bozkurt E, Arslan S, Acikel M, Erol MK, Gurlertop Y, Yilmaz M, Koca H, Atesal S (2007) Left atrial remodeling in acute anterior myocardial infarction. Echocardiography 24:243–251CrossRefPubMedGoogle Scholar
  5. 5.
    Antoni ML, ten Brinke EA, Marsan NA, Atary JZ, Holman ER, van der Wall EE, Schalij MJ, Bax JJ, Delgado V (2011) Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of 2-dimensional speckle tracking strain imaging. J Am Soc Echocardiogr 24:1126–1133CrossRefPubMedGoogle Scholar
  6. 6.
    Lamblin N, Fertin M, de Groote P, Bauters C (2012) Incidence, determinants and consequences of left atrial remodelling after a first anterior myocardial Infarction. Arch Cardiovasc Dis 105:18–23CrossRefPubMedGoogle Scholar
  7. 7.
    Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, Matetzky S, Behar S, Eldar M, Feinberg M (2004) Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol 44:327–334CrossRefPubMedGoogle Scholar
  8. 8.
    Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, Park SW, Bailey KR, Pellikka PA (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 107:2207–2212CrossRefPubMedGoogle Scholar
  9. 9.
    Lang RM, Bierig M, Devereux RB, Flachkamp FA, Foster E, Pelikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Chamber quantification writing group; American Society of Echocardiography’s guidelines and standards committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from The American Society of echocardiography’s Guidelines and Standards Committee and the Chamber quantification Writing Group, developed in conjunction with European Association of Echocardiography, a branch of European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRefPubMedGoogle Scholar
  10. 10.
    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133CrossRefPubMedGoogle Scholar
  11. 11.
    Stefano GT, Zhao H, Schluchter M, Hoit BD (2012) Assessment of echocardiographic left atrial size: accuracy of M-mode and two-dimensional methods and prediction of diastolic dysfunction. Echocardiography 29:379–384CrossRefPubMedGoogle Scholar
  12. 12.
    Hudsmith LE, Cheng AS, Tyler DJ, Shirodaria C, Lee J, Petersen SE, Francis JM, Clarke K, Robson MD, Neubauer S (2007) Assessment of left atrial volumes at 1.5 Tesla and 3 Tesla using FLASH and SSFP cine imaging. J Cardiovasc Magn Reson 9(673–9):00Google Scholar
  13. 13.
    Leung DY, Boyd A, Ng AA et al (2008) Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 156:1056–1064CrossRefPubMedGoogle Scholar
  14. 14.
    TIMI Study Group (1985) The Thrombolysis In Myocardial Infarction (TIMI) trial, phase 1 findings: TIMI Study Group. N Engl J Med 312:932–936CrossRefGoogle Scholar
  15. 15.
    Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ (2000) Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 283:2941–2947CrossRefPubMedGoogle Scholar
  16. 16.
    Steg PG, Cambou JP, Goldstein P, Durand E, Sauval P, Kadri Z, Blanchard D, Lablanche JM, Guéret P, Cottin Y, Juliard JM, Hanania G, Vaur L, Danchin N, USIC 2000 Investigators (2006) Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry. Heart 92(10):1378–1383CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Di Chiara A, Chiarella F, Savonitto S, Lucci D, Bolognese L, De Servi S, Greco C, Boccanelli A, Zonzin P, Coccolini S, Maggioni AP, BLIT Investigators (2003) Epidemiology of acute myocardial infarction in the Italian CCU network: the BLITZ study. Eur Heart J 24(18):1616–1629CrossRefPubMedGoogle Scholar
  18. 18.
    Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, Roumanis SA, Curtis JP, Nallamothu BK, Magid DJ, McNamara RL, Parkosewich J, Loeb JM, Krumholz HM (2006). Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355(22):2308–2320Google Scholar
  19. 19.
    Nijiland F, Kamp O, Karreman AJ, van Eenige MJ, Visser CA (1997) Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial doppler echocardiographic study. J Am Coll Cardiol 30:1618–1624CrossRefGoogle Scholar
  20. 20.
    Moller JE, Pellikka P, Kober L, Poulsen SH, Nayad O, Torp-Pedersen C (2003) Prognostic importance of systolic and diastolic function after acute myocardial infarction. Am Heart J 145:147–153CrossRefPubMedGoogle Scholar
  21. 21.
    Hillis GS, Moller JE, Pellikka PA, Gersh BJ, Wright RS, Ommen SR, Reeder GS, Oh JK (2004) Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 43:360–367CrossRefPubMedGoogle Scholar
  22. 22.
    MeRGE-AMI Collaborators (2008) Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation 117:2591–2598CrossRefGoogle Scholar
  23. 23.
    Prasad SB, See V, Brown P, McKay T, Narayan A, Kovoor P, Thomas L (2011) Impact of duration of ischemia on left ventricular diastolic properties following reperfusion for acute myocardial infarction. Am J Cardiol 108:348–354CrossRefPubMedGoogle Scholar
  24. 24.
    Otasevic P, Neskovic AN, Popovic Z, Vlahovic A, Bojic D, Bojic M, Popovic AD (2001) Short early filling deceleration time on day 1 after acute myocardial infarction is associated with short and long term left ventricular remodelling. Heart 85(5):527–532CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Braunwald E, Frahm CJ (1961) Studies on Starling’s law of the heart. IV. Observations on the hemodynamic functions of the left atrium in man. Circulation 24:633CrossRefGoogle Scholar
  26. 26.
    Murray JA, Kennedy JW, Figley MM (1968) Quantitative angiocardiography. II. The normal left atrial volume in man. Circulation 37:800CrossRefPubMedGoogle Scholar
  27. 27.
    Matsuda Y, Toma Y, Ogawa H, Matsuzaki M, Katayama K, Fujii T, Yoshino F, Moritani K, Kumada T, Kusukawa R (1983) Importance of left atrial function in patients with myocardial infarction. Circulation 67:566–571CrossRefPubMedGoogle Scholar
  28. 28.
    Anwar AM, Geleijnse ML, Soliman OII, Nemes A, ten Cate FJ (2007) Left atrial Frank-Starling law assessed by real-time, three dimensional echocardiographic left atrial volume changes. Heart 93:1393–1397CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Hsiao SH, Lin KL, Chiou KR (2012) Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol 109(5):748–755CrossRefPubMedGoogle Scholar
  30. 30.
    Giannitsis E, Steen H, Kurz K, Ivandic B, Simon AC, Futterer S, Schild C, Isfort P, Jaffe AS, Katus HA (2008) Cardiac magnetic resonance imaging study for quantification of infarct size comparing directly serial versus single time-point measurements of cardiac troponin T. J Am Coll Cardiol 51(3):307–314CrossRefPubMedGoogle Scholar
  31. 31.
    Kurz K, Schild C, Isfort P, Katus HA, Giannitsis E (2009) Serial and single time-point measurements of cardiac troponin T for prediction of clinical outcomes in patients with acute ST-segment elevation myocardial infarction. Clin Res Cardiol 98(2):94–100CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Ivan Ilic
    • 1
  • Ivan Stankovic
    • 1
  • Radosav Vidakovic
    • 1
  • Vladimir Jovanovic
    • 1
  • Alja Vlahovic Stipac
    • 1
  • BIljana Putnikovic
    • 1
  • Aleksandar N. Neskovic
    • 1
  1. 1.Department of Cardiology, Clinical Hospital Center Zemun, Faculty of MedicineUniversity of BelgradeBelgradeSerbia

Personalised recommendations