Left Atrial Dimension to Left Ventricle Ejection Fraction Ratio Can Predict Long-Term Major Adverse Events In Patients With Acute Coronary Syndrome

Abstract

Background: It is critical to specify the high-risk group in acute coronary syndrome following percutaneous coronary intervention. Left atrial diameter and Left ventricle ejection fraction are functional echocardiographic parameters for risk classification thanks to easy obtainable, cheap, and non-invasive nature. However, major adverse cardiovascular events may be predicted less than actual where ejection fraction or left atrial diameter are in the normal range. We aimed to assess the left atrial diameter to ejection fraction ratio for major adverse cardiovascular events prediction in acute coronary syndrome.
Materials and Methods: Individuals with acute coronary syndrome were included in the study. Atrial diameter and ejection fraction parameters were obtained at admission. The left atrial diameter to left ventricular ejection fraction ratio was calculated through atrial diameter dividing by ejection fraction, and the relationship between new-onset heart failure and all-cause mortality with this ratio was investigated for two years period.
Results: The mean age of total 262 patients were 62.1±11.5 years. Thirty-nine (18.9 %) of patients were female and major adverse cardiovascular events occurred in 73 (28%) of the patients. In the backward multivariable Cox regression analysis, age [Hazard ratio (HR)=1.039, 95%CI:1.017-1.060, p<0.001], Killip class [HR=2.099, 95%CI:1.011-4.365, p=0.045], serum creatinine level [HR=2.202, 95%CI:1.247-3.811, p=0.003], and left atrial diameter to left ventricular ejection fraction ratio [HR=1.029, 95%CI:1.019-1.038, p<0.001] were revealed to be independent predictors of major adverse events.
Conclusion: Left atrial diameter to left ventricular ejection fraction ratio were predictors of two years new-onset heart failure and mortality in acute coronary syndrome. This novel practical index may provide better prediction for adverse events in all patient groups.

Key Words: Acute coronary syndrome (ACS), Left atrial diameter (LAd), Left ventricle ejection fraction (LVEF), Left atrial diameter (LAd) to Left ventricle ejection fraction (LVEF) ratio (LAd/LVEF)

Keywords

• Acute coronary syndrome
• Left atrial diameter
• Left ventricle ejection fraction (

Akut Koroner Sendrom Hastalarında Sol Atriyal Çapın Sol Ventrikül Ejeksiyon Fraksiyonuna Oranı Uzun Dönem Major İstenmeyen Olayları Öngörebilir

Abstract

Amaç: Akut koroner sendromlu hastalarda perkütan koroner girişim sonrası yüksek riskli hastaların belirlenmesi oldukça önemlidir. Sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapı, kolay elde edilebilebilir, ucuz ve invaziv olmaması nedeniyle günlük klinik uygulamada risk sınıflandırması için fonksiyonel ekokardiyografik parametrelerdir. Bununla birlikte, majör istenmeyen kardiyovasküler olaylar, ejeksiyon fraksiyonu veya atrium çapının normal aralıkta olduğu durumlarda gerçek olandan daha az tahmin edilebilir. Bu nedenle, akut koroner sendrom hastalarında majör istenmeyen olay öngörüsü için sol atrium çapının sol ventrikül ejeksiyon fraksiyonuna oranının değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Çalışmaya akut koroner sendrom tanısı almış 262 hasta dahil edildi. Tüm hastalardan sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapları parametreleri başvuru sırasında elde edildi. Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, sol atrium çapın ejeksiyon fraksiyonuna bölünmesi ile hesaplandı. Çalışmanın bileşik birincil sonlanım noktası, tüm nedenlere bağlı ölüm ve yeni başlayan kalp yetmezliğiydi. Bulgular: Ortalama yaş 62.1±11.5 yıldı ve hastaların 39'u (%18.3) kadındı. Major istenmeyen kardiyovasküler olay 73 (%28) hastada meydana geldi. Geriye dönük çok değişkenli Cox regresyon analizinde, yaş [OR = 1.037, % 95 CI: 1.016-1.058, p <0.001], Killip sınıfı [OR = 2.097, % 95 CI: 1.009-4.361, p = 0.047], kreatinin düzeyi [OR = 2.200, % 95 CI: 1.271-3.807, p = 0.005] ve Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı [OR = 1.027, % 95 CI: 1.018-1.036, p <0.001] uzun süreli takip sırasında MACE'nin bağımsız prediktörleri olarak bulundu. Sonuç: Yaş, Killip sınıfı, kreatinin düzeyi ve Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, akut koroner sendrom hastalarında 2 yıllık takipte birleşik sonlanım noktasının bağımsız prediktörleriydi. Sol atriyal boyut ve ejeksiyon fraksiyonunun birlikte kullanılması, istenmeyen olayların öngörülmesi için kendi başlarına olduğundan daha fazla öngörü sağlayabilir.

Keywords

• akut koroner sendrom
• sol atrial çap
• sol ventrikül ejeksiyon fraksiyonu
• sol atrial çap-sol ventrikül ejeksiyon fraksiyonu oranı

References

1. Referans1 Tong DC, Wilson AM, Layland J. Novel risk factors for acute coronary syndromes and emerging therapies. Int J Cardiol. 2016;220:815–24.
2. Referans2 Blume GG, McLeod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM, et al. Left atrial function: Physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011;12(6):421–30.
3. Referans3 Hoit BD. Left atrial size and function: Role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505.
4. Referans4 Hamatani Y, Ogawa H, Takabayashi K, Yamashita Y, Takagi D, Esato M, et al. Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Sci Rep. 2016; 6:31042.
5. Referans5 Froehlich L, Meyre P, Aeschbacher S, Blum S, Djokic D, Kuehne M, et al. Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: A systematic review and meta-analysis. Heart. 2019;105(24):1884-1891.
6. Referans6 Siontis GCM, Branca M, Serruys P, Silber S, Räber L, Pilgrim T, et al. Impact of left ventricular function on clinical outcomes among patients with coronary artery disease. Eur J Prev Cardiol. 2019;26(12):1273–84.
7. Referans7 Aydogdu S, Güler K, Bayram F, Altun B, Derici Ü, Abaci A, et al. 2019 Turkish hypertension consensus report. Turk Kardiyol Dern Ars. 2019;47(6):535–46.
8. Referans8 Sonmez A, Haymana C, Bayram F, Salman S, Dizdar OS, Gurkan E, et al. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Res Clin Pract. 2018;146:138–47.

9. Referans9 Ahluwalia N, Dwyer J, Terry A, Moshfegh A, Johnson C. Update on NHANES dietary data: Focus on collection, release, analytical considerations, and uses to inform public policy. Adv Nutr. 2016;7(1):121–34.
10. Referans10 Stefano GT, Zhao H, Schluchter M, Hoit BD. Assessment of echocardiographic left atrial size: Accuracy of M-mode and two-dimensional methods and prediction of diastolic dysfunction. Echocardiography. 2012;29(4):379–84.
11. Referans11 Kobayashi A, Misumida N, Fox JT, Kanei Y. Prognostic Value of Left Ventricular End-Diastolic Pressure in Patients With Non-ST-Segment Elevation Myocardial Infarction. Cardiol Res. 2015;6(4–5):301–5.
12. Referans12 Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004;44(2):327–34.
13. Referans13 Tsang TSM, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: Is volume superior to area or diameter? J Am Coll Cardiol. 2006;47(5):1018–23.
14. Referans14 Gardin JM, McClelland R, Kitzman D, Lima JAC, Bommer W, Klopfenstein HS, et al. M-Mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (The Cardiovascular Health Study). Am J Cardiol. 2001;87(9):1051–7.
15. Referans15 Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death: The Framingham Heart Study. Circulation. 1995;92(4):835–41.
16. Referans16 Gupta DK, Shah AM, Giugliano RP, Ruff CT, Antman EM, Grip LT, et al. Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48. Eur Heart J. 2014;35(22):1457–65.
17. Referans17 Mo BF, Lu QF, Lu SB, Xie YQ, Feng XF, Li YG. Value of combining left atrial diameter and amino-terminal pro-brain natriuretic peptide to the CHA2DS2-VASc score for predicting stroke and death in patients with sick sinus syndrome after pacemaker implantation. Chin Med J (Engl). 2017;130(16):1902–8.
18. Referans18 Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K, et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: Losartan intervention for endpoint reduction in hypertension trial. Hypertension. 2007;49(2):311–6.
19. Referans19 Perelshtein Brezinov O, Klempfner R, Zekry S Ben, Goldenberg I, Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine (Baltimore). 2017;96(9):e6226.
20. Referans20 Bosch X, Théroux P. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2005;150(2):215–20.
21. Referans21 Pfeffer MA, Shah AM, Borlaug BA. Heart Failure with Preserved Ejection Fraction in Perspective. Circ Res. 2019;124(11):1598–617.
22. Referans22 Longobardo L, Zito C, Carerj S, Khandheria BK. Left atriumin heart failure with preserved ejection fraction: The importance of function before anatomy. Eur Heart J Cardiovasc Imaging. 2017;18(7):730–1.
23. Referans23 Redfield MM. Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2016;375(19):1868–77.
24. Referans24 Chan D, Doughty RN, Lund M, Lee M, Kerr AJ. Target Doses of Secondary Prevention Medications Are Not Being Achieved in Patients With Reduced Left Ventricular Ejection Fraction After Acute Coronary Syndrome (ANZACS-QI 34). Hear Lung Circ. 2020;29(9):1386–96.
25. Referans25 Anavekar NS, McMurray JJV, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351(13):1285–95.
26. Referans26 Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002;106(8):974–80.