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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 conventional 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 followup 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 systolic 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 classification on admission and 6 months later by NYHA classification. 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 significantly 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 Correspondence to: Dr. Mohamed M.R. Abd El-Aziz, E-Mail: mreda30688@gmail.com 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/m , E/e` ratio, EF were the most significant predictors of in-hospital HF with E/e` ratio being the most powerful predictor. (pvalue=0.001) and LAVI ml/m 2 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.

the medical journal of cairo university/the medical journal of cairo university

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