Determinants of atrial remodeling after first acute myocardial infarction: relationships with infarct severity, coronary anatomy and cardiovascular risk factors
B Couto Viana, T Prata-Branco, L Alves, E AndradeAbstract
Introduction
Atrial remodeling after acute myocardial infarction (AMI) is an important marker of hemodynamic load and cardiovascular risk [1,2]. This study examined, in first-episode AMI, the structural and biochemical determinants of atrial remodeling over 1 year, using ST-segment elevation status (STEMI/NSTEMI), troponin, Killip class, and left ventricular ejection fraction (LVEF) as indicators of infarction severity, and integrating coronary anatomy and chronic cardiovascular risk factors.
Purpose
To identify clinical, biochemical and angiographic factors associated with atrial remodelling during the first year following a first acute myocardial infarction.
Methods
We included 148 consecutive patients admitted with AMI (2013–2015) to a tertiary care center. Left atrial volume index (LAVI) and B-type natriuretic peptide (BNP) were measured at baseline and 12 months. Demographic, clinical, angiographic, and biochemical variables were related to structural and biomarker-based remodeling.
Results
Mean age was 54.5 ± 10.0 years; 87.2% were male; mean BMI was 27.2 ± 3.2 kg/m². Smoking was present in 74%, hypertension in 38.5%, diabetes mellitus in 15.6%, and dyslipidemia in 64.9%. STEMI accounted for 69.6% of cases. The left anterior descending artery (LAD) was involved in 52.4%, the circumflex in 17.0%, and the right coronary artery in 30.6%. Troponin correlated with 12-month LAVI (p = 0.002) and 12-month BNP (p < 0.001). STEMI patients had higher 1-year LAVI (p = 0.042). Higher Killip class was associated with elevated 12-month BNP (p = 0.005), larger 12-month LAVI (p = 0.033), and greater absolute and relative LAVI progression (both p = 0.002). Lower baseline LVEF related to higher 12-month BNP (p = 0.040) and LAVI (p = 0.028). LAD involvement predicted higher 12-month BNP (p = 0.002) and showed a borderline association with higher 12-month LAVI (p = 0.073). Among chronic risk factors, only diabetes mellitus was associated with higher 12-month BNP (p = 0.020) and showed a trend toward greater LAVI progression (p = 0.063).
Conclusions
Atrial remodeling after first-episode AMI appeared consistently associated with multiple indicators of infarction severity, suggesting hemodynamic burden as a major contributor. Although the circumflex and right coronary arteries supply atrial branches, they showed no associations with remodeling in this cohort. Coronary anatomy therefore seemed to act mainly as a surrogate for infarct extent, particularly regarding LAD involvement. Diabetes mellitus emerged as a potential chronic modifier of the atrial response and warrants further investigation.Graphical AbstractFor image description, please refer to the figure legend and surrounding text.