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

Yıl 2021, Cilt: 18 Sayı: 2, 329 - 335, 27.08.2021

Ömer Faruk Çırakoğlu , Ahmet Seyda Yılmaz , Göksel Çinier , Mustafa Çetin

https://doi.org/10.35440/hutfd.948089

Öz

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)

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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