The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Left Atrial Volume is a Predictor of Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction

급성 심근경색증 환자에서 예후 예측인자로서 좌심방 용적지수

  • Lee, Ji Sun (The Heart Center of Chonnam National University Hospital) ;
  • Jeong, Myung Ho (The Heart Center of Chonnam National University Hospital) ;
  • Rhee, Jung Ae (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Jin Su (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Yoon, Hyun Joo (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Kye Hun (The Heart Center of Chonnam National University Hospital) ;
  • Hong, Young Joon (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Ju Han (The Heart Center of Chonnam National University Hospital) ;
  • Ahn, Young Keun (The Heart Center of Chonnam National University Hospital) ;
  • Cho, Jeong Gwan (The Heart Center of Chonnam National University Hospital) ;
  • Park, Jong Chun (The Heart Center of Chonnam National University Hospital) ;
  • Kang, Jung Chaee (The Heart Center of Chonnam National University Hospital)
  • 이지선 (전남대학교병원 심장센터) ;
  • 정명호 (전남대학교병원 심장센터) ;
  • 이정애 (전남대학교 의과대학 예방의학교실) ;
  • 최진수 (전남대학교 의과대학 예방의학교실) ;
  • 윤현주 (전남대학교병원 심장센터) ;
  • 김계훈 (전남대학교병원 심장센터) ;
  • 홍영준 (전남대학교병원 심장센터) ;
  • 김주한 (전남대학교병원 심장센터) ;
  • 안영근 (전남대학교병원 심장센터) ;
  • 조정관 (전남대학교병원 심장센터) ;
  • 박종춘 (전남대학교병원 심장센터) ;
  • 강정채 (전남대학교병원 심장센터)
  • Received : 2012.10.31
  • Accepted : 2012.12.27
  • Published : 2014.01.01
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Abstract

Background/Aims: Diastolic dysfunction may develop in conjunction with or without systolic dysfunction in patients with acute myocardial infarction (AMI). The present study investigated the association between left arterial (LA) volume and major adverse cardiac events (MACE) in 772 patients with AMI. Methods: The patients were divided into groups according to LA volume index (LAVI) measured using echocardiography according to the American Society of Echocardiography guidelines: $LAVI{\geq}40mL/m^2$ (Group I: n = 260, 191 males; age, $71.1{\pm}10.8$ years) and LAVI < $40mL/m^2$ (Group II: n = 512, 432 males; age, $62.8{\pm}12.7$ years). The mean observational period was $314.2{\pm}134.6$ days. Results: Group I patients were older than those in Group II. Hypertension (56.8% vs. 46.0%, respectively; p = 0.007) and advanced Killip class (42.6% vs. 21.0%, respectively; p < 0.001) were more frequent in Group I than in Group II. MACE was more prevalent in Group I than in Group II (20.3% vs. 13.7%, respectively; p = 0.037). MACE-free survival rates were higher in Group II than in Group I during clinical follow-up. The multivariate analysis revealed that high LAVI was an independent predictor of mortality (hazard ratio, 3.002; confidedce interval, 1.051-8.569; p = 0.040). Conclusions: LA volume is an independent predictor of adverse cardiac events in patients with AMI, and the LAVI is useful for AMI risk stratification.

목적: 급성 심근경색증 환자에서 좌심실의 이완기능 장애는 환자의 예후와 관련되어 있다고 알려져 있다. 심장 초음파로 측정된 대부분의 도플러 지표들은 환자의 혈역학적 변화에 영향을 받아 이완기능 장애 정도를 정확하게 표현하기 어려운 반면, 좌심방 용적지수는 좌심실 충만압을 나타내는 비교적 안정적 지표이다. 따라서 이 연구의 목적은 급성 심근경색증 환자에게서 입원 당시 측정된 좌심방 용적지수에 따른 임상경과의 차이를 파악하고자 하였다. 방법: 2008년1월부터 2010년 12월까지 급성 심근경색증으로 전남대학교병원에 입원한 환자 1,906명 중 심장초음파 검사가 시행되고 관상동맥 중재술을 시술받고 1년 동안 임상관찰이 되어 분석 가능한 772명($64.1{\pm}12.8$세, 남자 80%)을 대상으로 하였다. 좌심방 용적지수가 $40mL/m^2$ 이상인 I군 260명($71.1{\pm}10.8$세, 남자 191명)과 좌심방 용적지수가 $40mL/m^2$ 미만인 II군 512명($62.8{\pm}12.7$세, 남자 432명)으로 분류하여 양 군 사이의 임상적 특성과 1년간 사망을 포함한 주요 심장사건을 분석하였다. 결과: 급성 심근경색증 후 1년간 추적조사한 결과, 주요 심장사건은 총 120예(15.5%)에서 발생하였으며 이 중 사망은 18예(2.3%)에서 관찰되었다. I군이 II군에 비하여 주요 심장사건의 발생률이 높았고(20.3% vs. 13.7%, p = 0.037) 사망률 또한 유의한 차이를 보였다(15.5% vs. 2.0%, p = 0.023). 다변량 분석 결과 증가된 좌심방 용적지수(HR, 3.002; CI, 1.051 to 8.569; p = 0.040)가 사망률과 관련된 독립적 예측인자였다. 결론: 좌심방 용적지수는 급성 심근경색증 환자의 예후에 대한 독립적 예측인자이었으며 좌심방 용적의 측정은 심근경색증 후 고위험 환자군 분류에 유용할 것으로 기대된다.

Keywords

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