Background: Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied. Methods:We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling.Results: LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5-31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/ m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariate analysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001).Conclusions: Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term refl ects better than standard echocardiographic indices LV diastolic fi lling impairment.

Despite tremendous progress in the therapeutic algorithms of hemodynamically unstable patients, cardiogenic shock remains a clinical challenge with high mortality rate. Conservative management with inotropic agents remains the first-choice treatment, though it has been associated with serious adverse events and is not always adequate. Circulatory support with mechanical devices has been widely implemented in patients with cardiogenic shock during high-risk percutaneous coronary interventions or post-cardiac surgery complications and has been associated with favorable outcomes. In patients with acute decompensated heart failure, ventricular assist devices have been used to prolong the recovery period and reverse the cause of hemodynamic instability. In the present review, we discuss the current evidence on the use of percutaneous assist devices for the treatment of cardiogenic shock, plus we highlight the need for future evolution in this particular field that may permit the optimal choice of each device for different patients or clinical situations.