Left Atrial Volume Index (LAVI) as a Predictor of Outcome for First Time ST Elevation Myocardial Infarction (STEMI), Compared to Other Conventional Echocardiographic Parameters of Left Ventricular (LV) Function

Abstract
Background: Acute Heart Failure (AHF) complicates acute Myocardial Infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of Left Atrial Volume Index (LAVI) compared to other con-ventional parameters of systolic and diastolic Left Ventricular function (LV) in patients with first time ST Segment Elevation Myocardial Infarction (STEMI), in predicting in-Hospital Heart failure (HF), in-hospital mortality and development of heart failure and subsequent rehospitalisation over a follow-up period of 6 months.
Material and Methods: The present study is a prospective observational study conducted in the Cardiology Department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to Coronary Care Unit (CCU). Left Ventricular Ejection Fraction (LVEF), LV End-Systolic and End-Diatolic Dimensions (LVESD and LVEDD), LAVI, diastolic and systo-lic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with the development of heart failure according to Killip classifi-cation on admission and 6 months later by NYHA classifica-tion.
Results: There was a statistically significant difference regarding development of in-hospital HF (Killip classification >II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function except Isovolumetric Relaxation Time (IVRT) and E/A ratio, whereas in-hospital mortality was related signifi-cantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. (p-value <0.001).
After 6 months of follow-up, there was a statistically significant relation between mortality development and the following variables; LAVI, EF, Deceleration Time (DT), IVRT, TDI (tissue Doppler imaging) septal e` and E/e` by univariate analysis. (p-value <0.001).
A statistically significant correlation between development of HF symptoms according to NYHA classification and subsequent rehospitalization was observed with the previously mentioned variables except DT and IVRT by univariate analysis. (p-value <0.001).
LAVI, EF, TDI septal é and E/é ratio had a statistically significant correlation with development of in-hospital HF (p-value <0.001), but only E/é ratio and TDI septal e` were significantly related to in-hospital mortality (p-value <0.05). All the previously mentioned four variables were significant predictors of mortality or symptoms of HF and rehospitalization over six months follow-up. (p-value <0.05).
Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital HF with E/e` ratio being the most powerful predictor. (p-value=0.001) and LAVI ml/m2 was the most powerful predictor of mortality during the follow up period. (p-value=0.03).
Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of HF and mortality both in the in-hospital setting and after a follow-up period of 6 months.
LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor, LAVI and EF were the most powerful predictors of mortality and HF during a follow-up period of 6 months respectively.