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Title LEFT ATRIAL FUNCTION PREDICTS CLINICAL OUTCOMES IN PATIENTS FOLLOWING ST ELEVATION MYOCARDIAL INFARCTION: A STUDY WITH RAPID SEMI-AUTOMATED STRAIN DERIVED FROM CARDIOVASCULAR MAGNETIC RESONANCE |
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Type Young Investigator Award |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Basic Science |
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Main Author Shuang Leng1 |
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Presenting Author Shuang Leng1 |
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Co-Author Heng Ge2 Jie He2 Lingcong Kong2 Ru-San Tan1 4 Xiaodan Zhao1 Derek Hausenloy1 3 Liang Zhong1 3 |
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Department / Institution / Country National Heart Research Institute Singapore / National Heart Centre Singapore / Singapore1 Department of Cardiology / Renji Hospital, School of Medicine, Shanghai Jiaotong University / China (中国)2 Programme in Cardiovascular & Metabolic Disorders / Duke-NUS Medical School / Singapore3 SingHealth Duke-NUS Cardiovascular Sciences Academic Clinical Programme / Duke-NUS Medical School / Singapore4 |
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Objective(s) The left atrium (LA) modulates left ventricular (LV) filling and cardiac performance in a complex manner that comprises discrete reservoir, conduit and booster pump phases. Routine clinical assessment of LA function is limited to simple measurements of maximal LA volume, area or maximal diameter, belying the complex phasic LA-LV interactions, and may thus be inadequate for characterizing LA phasic function comprehensively and fail to glean the full diagnostic and prognostic potentials. We have developed novel semi-automated image post-processing software to measure LA phasic strain parameters from cine standard cardiovascular magnetic resonance (CMR). The aim of the present study is to evaluate the prognostic importance of LA phasic strain parameters in patients after ST elevation myocardial infarction (STEMI). |
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Material and Method In 321 patients, CMR scans were performed 3 to 7 days after STEMI. LA phasic strains and strain rates were analyzed using in-house software to post-process standard cine 4- and 2-chamber CMR images. The incidence of the primary endpoint, a composite of death, re-infarction, stroke and heart failure was censored during the follow-up [median: 3.7 years (inter-quartile range: 2.7 – 4.8 years)]. |
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Result(s) Reduced LA reservoir and conduit strains were significantly associated with larger infarct size expressed as a percentage of LV mass (r = -0.36 and -0.33, respectively, both P < 0.0001). A total of 77 patients (24%) met the primary endpoint. In Cox regression analysis adjusting for known risk factors (including infarct size), LA reservoir strain [adjusted hazard ratio (HR): 0.89; 95% confidence interval (CI): 0.85 – 0.94; P < 0.0001] and conduit strain [adjusted HR: 0.83; 95% CI: 0.76 – 0.91; P < 0.0001] remained independently associated with the primary outcome. |
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Conclusion In STEMI patients, impaired LA strains were associated with larger infarct size, and were independent predictors of adverse clinical outcome, and therefore should be considered as a useful adjunct to established markers. |