Left atrial volume index in diabetic hypertensive patients with acute myocardial infarction

Abstract

Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) dimension is a marker of LV filling pressure, reflecting the severity and chronicity of diastolic dysfunction. LA is a stable parameter that combines chronic cardiovascular conditions effects and acute increase in filling pressure in acute myocardial infarction. Patients with acute coronary syndrome and increased left atrial volume index (LAVI) have a worse long-term prognosis. In patients with hypertension and diabetes, an increase in the LA dimension predicts cardiovascular events. There are limiting data about the impact of LAVI on the outcome in diabetic hypertensive patients with ST-elevation myocardial infarction (STEMI). Purpose: of the study was to compare LAVI in diabetic and nondiabetic hypertensive patients admitted with STEMI. Methods: ninety-eight hypertensive patients admitted with STEMI were enrolled, sixty-seven with diabetes mellitus and thirty-one without diabetes. The patients with atrial fibrillation and significant valvular disease were not included in the study. The evaluation consisted in clinical examination, echocardiographic measurements, laboratory tests, and 12 leads electrocardiography. 2D Echocardiography area-length technique was used for LA volume measurement. The LA endocardial borders were traced in both the apical four- and two-chamber views, and the results were body surface area indexed. The cut of value was 34ml/m2. The Devereaux formula determined left ventricle mass index (LVMI), and the ranges were: 125 kg/m2 for males and 95 mg/m2 for females. Left ventricle ejection fraction (LVEF) was < 50% in all cases. Measurements were obtained in the first week after STEMI. The patients were divided into two groups: the first was between 40 and 60 years and the second was above 60 years. According to the age group, mean values (MV) and standard deviation (SD) were calculated, obtaining a comparison between diabetic and nondiabetic patients. Results: LAVI had higher values in diabetic patients: MV: 37.37 (SD: 3.39, CV: 9.07%) compare with nondiabetic patients: MV: 31.07 (SD: 2.67, CV 8.59%), p < 0.0001. Between 40-60 years LAVI MV were 36.43 +/- 3.21 in diabetic patients vs. 29.62+/-1.89 in nondiabetic patients (p = 0.0001); above 60 years of age LAVI MV were: 38.99 +/- 3.04 in diabetic patients and 31.14 +/- 2.8 in nondiabetics patients (p < 0.0001). In both group of age LAVI also correlated with body mass index, LVMI, LV volumes, LV diastolic dysfunction, LVEF, dyslipidemia and smoking. Conclusions: 1. In hypertensive patients admitted with STEMI, diabetes mellitus was an additional factor contributing to increased left atrium dimensions. 2. This study showed a correlation between LAVI and other factors involved in increasing LV filling pressure in hypertensive diabetic patients admitted with STEMI, underlying the importance of LA enlargement evaluation. Further studies with a larger number of patients are need to confirm these results.