Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis

Abstract

Background: New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI.

Materials and methods: MEDLINE^®, EMBASE^® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3.

Result: We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was -4.91 units (95% Cl: -5.70 to -4.12), test for overall effect z-score = 12.18 (p < 0.00001, I² = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 (p < 0.00001, I² = 57%).

Conclusions: Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

Keywords: acute myocardial infarction; atrial fibrillation; left atrium diameter; left ventricular ejection fraction.

Figure 1. Flow diagram of the trial-selection process

AF = atrial fibrillation; AMI = acute myocardial infarction; LVEF = left ventricular ejection fraction.

Figure 2. Comparison of LVEF levels between AF and without AF groups in the 10 included studies

CI = confidence interval; AF = atrial fibrillation; LVEF =left ventricular ejection fraction.

Figure 3. Funnel plot of the 10 included studies

SE = standard error; MD = mean difference.

Figure 4. Comparison of LAD levels between AF and without groups in the 7 included studies

CI = confidence interval; AF = atrial fibrillation; LAD = left atrium diameter.

Figure 5. Comparison of LAD levels between AF and without groups in the remaining 6 included studies

CI = confidence interval; AF = atrial fibrillation; LAD = left atrium diameter.