AUTHOR=Li Zhitong , Wang Xin , Liu Quanbo , Li Chenglin , Gao Jinghan , Yang Yiheng , Wang Binhao , Hidru Tesfaldet H. , Liu Fei , Yang Xiaolei , Xia Yunlong 

TITLE=Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1025842

DOI=10.3389/fcvm.2022.1025842

ISSN=2297-055X

ABSTRACT=Background: Contemporary data on atrial cardiomyopathy(ACM) markers and ischemic cerebrovascular events (ICVE) in patients with acute myocardial infarction(AMI) is lacking. This study investigated the association between ACM markers and ICVE in patients with AMI.
Methods: We retrospectively analyzed 4206 patients with AMI without a documented history of AF. We measured markers of ACM including P-wave terminal force in ECG lead V1(PTFV1), left atrial diameter(LAD) and B-type natriuretic peptide(BNP).  Left atrial enlargemrnt(LAE) and abnormal PTFV1 was defined by previously published cut-off points. The primary outcome was incident ICVE composed of ischemic stroke and transient ischemic attack(TIA). Receiver operating curve analyses, incremental discrimination improvement(IDI) and net reclassification(NRI) were used to compare the CHA2DS2-VASc score with LAE and abnormal PTFV1 to CHA2DS2-VASc score alone.
Results: During a median follow-up of 44.0 months, 229 (5.44%) ICVE (156 ischemic strokes and 73 TIAs)occurred.  Individuals with ICVE had larger PTFV1, LAD and BNP levels at baseline.  In multivariate analysis we found significant associations with ICVE for PTFV1 (HR per 1,000 μV*ms, 1.143; 95% CI, 1.093-1.196), LAD(HR per millimeter, 1.148; 95% CI, 1.107-1.190), but not BNP after adjusting for known ICVE risk factors and interim AF. The addition of abnormal PTFV1 and LAE improved the predictive accuracy of CHA2DS2-VASc score with C-statistic increasing from 0.708 to 0.761(p <0.001).
Conclusions:ACM markers including PTFV1 and LAD were associated with incident ICVE independent of known risk factors and AF occurrence. Assessment of ACM markers may add further information in stratifying individuals at risk for ICVE in patients with AMI.