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Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction.

Authors
Ahn, SG; Shin, JH; Koh, BR; Choi, JH; Kang, SJ; Choi, BJ; Choi, SY; Yoon, MH; Hwang, GS; Tahk, SJ
Citation
Coronary artery disease, 17(7):597-603, 2006
Journal Title
Coronary artery disease
ISSN
0954-69281473-5830
Abstract
OBJECTIVES: To investigate the impact of myocardial perfusion on left atrial remodeling and its determinants after primary percutaneous coronary intervention for acute myocardial infarction.



BACKGROUND: Left atrial volume is an important predictor of morbidity and mortality in acute myocardial infarction, while thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade is an angiographic index associated with infarct size and mortality. As yet, however, the relationship between TMP grade and left atrial remodeling has not been investigated.



METHODS: Conventional transthoracic echocardiography was performed in 105 patients (55+/-13 years old, 92 men) with acute myocardial infarction within 24 h and after 6 months (mean 9+/-4, range 6-29 months) following successful primary percutaneous coronary intervention. Absolute left atrial volume was calculated using an elliptical model. Myocardial perfusion was evaluated, using TMP grade, by visual assessment on the coronary angiogram. Patients were divided into three groups on the basis of myocardial perfusion status, as TMP 0/1 (n=36), TMP 2 (n=36) and TMP 3 (n=33).



RESULTS: No difference was observed between baseline and follow-up left atrial volumes in the overall study population (42.5+/-16.1 vs. 43.5+/-17.4 ml, P=0.519). As regards TMP grade, follow-up left atrial volume significantly increased in the TMP 0/1 group (43+/-17 vs. 54.6+/-1.1 ml, P<0.001) and significantly decreased in the TMP 3 group (42.9+/-15.7 vs. 35.5+/-12.2 ml, P=0.001) compared with initial values. No change was observed in left atrial volume in the TMP 2 group. Multivariate analysis showed that TMP grade (P<0.001) and anterior location of myocardial infarction (P<0.001) were independent determinants of left atrial remodeling.



CONCLUSIONS: These results suggest that poor myocardial perfusion and anterior location of myocardial infarction can affect left atrial remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. It appears that adequate myocardial perfusion is crucial to prevent left atrial remodeling, a poor prognostic factor in acute myocardial infarction.
MeSH terms
AdultAgedAngioplasty, Balloon, Coronary*Atrial Function, Left*Coronary AngiographyCoronary Vessels/physiopathology*EchocardiographyFemaleHeart Atria/anatomy & histology*Heart Atria/radiographyHeart Atria/ultrasonographyHumansMaleMiddle AgedMyocardial Infarction/diagnosisMyocardial Infarction/mortalityMyocardial Infarction/therapy*Organ SizePrognosisTreatment Outcome
DOI
10.1097/01.mca.0000236281.74361.d4
PMID
17047443
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
신, 준한강, 수진최, 병주최, 소연윤, 명호황, 교승탁, 승제
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