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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

Abstract

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.

Keywords

Left atrial volume Ischemic time Diastolic dysfunction Myocardial infarction 

Abbreviations

ADM

Hospital admission

BMI

Body mass index

BSA

Body surface area

CABG

Coronary artery bypass grafting

CAD

Coronary artery disease

CI

Confidence interval

CVA

Cerebrovascular accident

Cx

Circumflex

EF

Ejection fraction

LA

Left atrium

LAD

Left anterior descending

LAEF

Left atrial ejection fraction

LAVI

Left atrial volume index

LV

Left ventricle

LVEDP

Left ventricular end diastolic pressure

MI

Myocardial infarction

OR

Odds ratio

PAD

Peripheral arterial disease

PCI

Percutaneous coronary intervention

RCA

Right coronary artery

RFP

Restrictive filling pattern

STEMI

ST-segment elevation myocardial infarction

SV

Stroke volume

TIMI

Thrombolysis in myocardial infarction

Notes

Acknowledgments

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.

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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

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