Document Detail

Risk stratification for recurrent heart failure in patients post-myocardial infarction with electrocardiographic and echocardiographic left atrial abnormality.
MedLine Citation:
PMID:  18471444     Owner:  NLM     Status:  MEDLINE    
Left atrial enlargement is predictive of cardiovascular events. The predictive power, however, of the combination of electrocardiographic (LAE-ECG) and echocardiographic left atrial enlargement (LAE-Echo) has not been extensively evaluated. We prospectively identified patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) who developed new-onset heart failure during admission. Baseline electrocardiograms obtained < or =12 months before admission were evaluated for LAE-ECG, such as prolonged P-wave duration or positive P-wave terminal force in lead V1, and in-hospital echocardiographic reports obtained < or =1 month after admission were assessed for linear, anteroposterior LAE-Echo. Follow-up was directed toward pertinent cardiovascular events and death. Of the 462 patients with NSTEMI, 108 developed new-onset heart failure (23%); 71 patients had LAE-Echo. Follow-up was 23.2 months (mean 22.1 months). Although in-hospital (early) cardiovascular complications (other than heart failure) were not significantly higher in patients with LAE-Echo, these patients demonstrated more postdischarge (late) cardiovascular complications, predominantly recurrent heart failure. In addition, those with a combination of LAE-Echo and LAE-ECG demonstrated significantly higher recurrence of heart failure (hazard ratio 1.52, 95% confidence interval 1.12 to 4.35; p = 0.02 for interatrial conduction delay, and hazard ratio 1.07, 95% confidence interval 1.01 to 3.27 for P-wave terminal force in lead V1; p = 0.03) and increased mortality compared with those with LAE-Echo alone. In conclusion, our data suggest that a combination of electrical and mechanical left atrial dysfunction is significantly more predictive of increased cardiovascular events and mortality compared with left atrial mechanical dysfunction alone.
Vignendra Ariyarajah; Maciej Malinski; Shelley Zieroth; Robert Harizi; Andrew Morris; David H Spodick
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-03-17
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-12     Completed Date:  2008-06-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1373-8     Citation Subset:  AIM; IM    
Division of Cardiology, Department of Medicine, St. Boniface General Hospital/University of Manitoba, Winnipeg, Manitoba.
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MeSH Terms
Atrial Function / physiology*
Cardiomyopathy, Dilated / diagnosis,  epidemiology*,  etiology
Echocardiography / methods*
Electrocardiography / methods*
Follow-Up Studies
Heart Atria / physiopathology,  ultrasonography*
Heart Failure / diagnosis,  epidemiology*,  etiology
Massachusetts / epidemiology
Myocardial Infarction / complications*,  physiopathology
Prospective Studies
Risk Assessment / methods
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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