Risk Stratification for Recurrent Heart Failure in Patients Post-Myocardial Infarction With Electrocardiographic and Echocardiographic Left Atrial Abnormality

Ariyarajah, Vignendra; Malinski, Maciej; Zieroth, Shelley; Harizi, Robert; Morris, Andrew L.; Spodick, David H.

doi:10.1016/j.amjcard.2008.01.013

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…LAA was seen in 17% of women and predicted both decreased recovery of LV function and decreased event‐free survival. This finding is similar to that reported in a study of 468 patients with heart failure after non‐ST‐elevation myocardial infarction, in which electrocardiographic LAA was associated with higher risk of recurrent heart failure and mortality . As noted, LAA by ECG was only 38% sensitive for left atrial enlargement as assessed by echocardiography.…”

Section: Discussionsupporting

confidence: 90%

Electrocardiographic findings in peripartum cardiomyopathy

Honigberg

Elkayam

Rajagopalan

et al. 2019

Clinical Cardiology

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Background There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods Standard 12‐lead ECGs were obtained at enrollment in the Investigations of Pregnancy‐Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST‐segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event‐free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T‐wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event‐free survival at 1 year (100% vs 85%, P = 0.01). Conclusions ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event‐free survival, and a normal ECG predicted favorable event‐free survival.

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Section: Discussionsupporting

confidence: 90%

Electrocardiographic findings in peripartum cardiomyopathy

Honigberg

Elkayam

Rajagopalan

et al. 2019

Clinical Cardiology

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“…LA enlargement has a prognostic role in CHF [22]. LA area index has shown its diagnostic value for CHF with preserved left ventricular systolic function in patients with HT [23].…”

Section: Significance Of La Function In Chfmentioning

confidence: 99%

Decreased Mechanical Function of Left Atrium Assessed by Speckle Tracking and Tissue Doppler Echocardiography in Patients with Congestive Heart Failure

Tsai

Liu

Huang

et al. 2012

Journal of Medical Ultrasound

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KEY WORDScongestive heart failure, left atrium, speckle tracking echocardiography, strain, strain rate Mechanical dysfunction of left atrium (LA) could be documented by tissue Doppler and speckle tracking echocardiography in patients with congestive heart failure (CHF). This study included 28 CHF, 46 untreated hypertension (HT), and 52 normal (NM) individuals with normal sinus rhythm. LA volumes and emptying fraction (LAEF) were measured by biplane area-length method. Peak LA strain (LAS) and strain rate (LASR) measured from speckle tracking echocardiography were identified as the peak negative deflection after P-wave. Tissue velocity (LATV) and tissue Doppler-derived strain (LATS) of LA were also used as indices of LA mechanical function. LAEF, LAS, LASR, LATV, and LATS were significantly lower in CHF than in HT and NM. After multivariate analysis controlling for age and sex, LAS, LASR, and LATV were still significantly lower in CHF. LASR was significantly correlated with LAEF. In conclusion, LA mechanical function was decreased in patients with CHF. ª

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“…Assessment of left ventricular systolic function, even among patients who are troponin negative, is an important predictor of long-term risk (12), and this new finding supports the upgrading of the recommendation to assess systolic function from Class IIa to Class I in the updated ACC/AHA guidelines (1). Echocardiography can also identify left atrial dilation (13), functional mitral regurgitation (14), and diastolic dysfunction (15), each of which has been shown to be associated with an adverse prognosis. At the other end of the risk spectrum, a normal computed tomographic angiogram (CTA) can expeditiously identify low-risk patients, thereby reducing unnecessary admissions (Fig.…”

Section: Risk Stratificationmentioning

confidence: 99%