Risk Stratification for Recurrent Heart Failure in Patients Post-Myocardial Infarction With Electrocardiographic and Echocardiographic Left Atrial Abnormality
Abstract
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.
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ECG signs of left atrial abnormality (a prolonged P-wave duration or positive P-wave terminal force in lead V1), if coupled with echocardiographic left atrial abnormalities, increase the predictive value for recurrence of heart failure and mortality compared to the predictive value of echocardiographic left atrial abnormalities alone.
“ECG signs of left atrial abnormality, i.e., a prolonged P-wave duration or positive P-wave terminal force in lead V 1 , if coupled with echocardiographic left atrial abnormalities, increased the predictive value for recurrence of heart failure and mortality, compared to the predictive value of this last test alone.50”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [50]
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- Authors
- Ariyarajah, V., Malinski, M., Zieroth, S., Harizi, R., Morris, A., & Spodick, D. H.
- Affiliations
- St. Boniface Hospital (CA)
- Sherman Hospital (US)
- Saint Vincent Hospital (US)
- ORCID
- Zieroth, Shelley
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 101
- Issue
- 10
- Pages
- 1373-1378
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1990713889
- Cited by
- 11
- References
- 23
- Citations by year
- 2019: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- left atrial enlargement, heart failure recurrence, non-ST-elevation myocardial infarction, risk stratification, P-wave duration, P-wave terminal force, interatrial conduction delay, left atrial dysfunction, cardiovascular events, mortality, electrocardiogram, echocardiography
- MeSH terms
- Aged, Cardiomyopathy, Dilated, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Heart Atria, Heart Failure, Humans, Male, Massachusetts, Myocardial Infarction, Prospective Studies, Recurrence, Risk Factors, Prevalence, Atrial Function, Risk Assessment
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