International Journal of Medical Science in Clinical Research & Review 
Online ISSN: 2581-8945 
Available Online at https://ijmscrr.in/ Volume 9|Issue 03 (May-June) |2026 |Page: 247-250 
IJMSCRR: May-June, 2026                                                                                                                                     Page | 247  
© 2026 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License (CC BY 
4.0). https://creativecommons.org/licenses/by/4.0/ 
Open Access      
Original Research Paper 
Left atrial volume index measurement and LA strain in acute coronary 
syndrome patients and its correlation with outcome 
 
Authors: 
Dr. Pradip Kumar Ghoshal
1
, Dr. Rajarshi Mondal
2
, Dr. Shreyangsha Chowdhury
3
  
1
Associate Professor, Department of Cardiology, IPGMER & SSKMH, Kolkata, India. 
2
Assistant Professor, Department of Cardiology, IPGMER & SSKMH, Kolkata, India.  
3
Post-Doctoral Trainee, Department of Cardiology, IPGMER & SSKMH, Kolkata, India. 
Corresponding Author: 
Dr. Rajarshi Mondal, Assistant Professor, Department of Cardiology, IPGMER & SSKM Hospital, Kolkata, India 
Email: mrinmoy31@gmail.com 
DOI: https://doi.org/10.5281/zenodo.20018843   
Received: 18-April-2026, Accepted: 03-May-2026, Online First: 04-May-2026 
ABSTRACT: 
Background: Acute coronary syndrome (ACS) is associated with substantial morbidity and mortality. Echocardiographic 
markers of left atrial (LA) size and function may improve risk stratification. Objective: To evaluate the association of left 
atrial  volume  index  (LAVI)  and  LA  strain  with  clinical  characteristics  and  1-year  adverse  outcomes  (major  adverse 
cardiovascular  events,  MACE)  in  ACS.  Methods:  Hospital-based  prospective  observational  study  (n=50).  Two-
dimensional echocardiography was performed within 48 hours of admission with follow-up at 6 and 12 months. Patients 
were grouped by LAVI (> 34 vs. ≤ 34 mL/m2). Outcomes included cardiovascular death (primary) and MACE (secondary). 
Results: MACE occurred in 13/50 (26%). LAVI and LA strain were significantly associated with MACE at 6 and 12 months 
(both p < 0.05), while associations at presentation were not significant. Conclusion: In this cohort, follow-up measures of 
LAVI and LA strain were associated with MACE, suggesting potential value for monitoring after ACS; larger studies are 
needed to refine thresholds and confirm prognostic performance. 
 
Keywords:  Acute  Coronary  Syndrome;  Left  Atrial  Volume  Index;  Left  Atrial  Strain;  Speckle  Tracking 
Echocardiography; Major Adverse Cardiovascular Events; Risk Stratification; Prognosis 
 
INTRODUCTION: 
Acute  coronary  syndrome  (ACS)  encompasses  a  wide 
range of presentations including unstable angina, non–ST-
segment  elevation  myocardial  infarction  (NSTEMI),  and 
ST-segment elevation myocardial infarction (STEMI), and 
remains a major contributor to mortality and morbidity 
worldwide.  Despite  advances  in  ACS  management 
strategies, the incidence of major adverse cardiovascular 
events (MACE) remains high [1]. 
Elevated left ventricular filling pressure (LVFP) is a key 
prognostic  indicator  of  cardiovascular  out-comes,  as 
classically described by Killip et al. [2]. Forrester et al. 
highlighted  pulmonary  capillary  wedge  pressure  as  a 
surrogate marker of left atrial pressure, underscoring the 
importance of LVFP assessment [3]. 
The left atrium (LA) is a critical interface between the 
pulmonary  veins  and  the  left  ventricle.  The  left atrial 
volume index (LAVI) is a recommended parameter for 
assessing LA remodeling and has  been associated with 
adverse  outcomes  [4,  5].  However,  LAVI  primarily 
reflects  the  cumulative  effect  of  chronically  elevated 
filling pressures and may not fully capture acute functional 
deterioration in short time windows. 
LA  strain,  derived  from  speckle-tracking 
echocardiography, is an emerging marker of LA intrinsic 
function and has been shown to correlate with LVFP and 
detect  earlier  functional  impairment  than  volumetric 
indices [6, 7]. This study investigated the relationship of 
LAVI and  LA  strain  with  clinical  features  and  1-year 
outcomes in ACS. 
 
Aims and objectives: 
To determine the relationship of LAVI and LA strain with 
clinical presentation, co-morbidities, and adverse events 

IJMSCRR: May-June, 2026 Page | 248

in ACS patients at admission and during 1-year follow-

up.

MATERIALS AND METHODS:

This hospital-based prospective observational study was

conducted in the Department of Cardiology, IPGMER and

SSKM Hospital, Kolkata. Patients meeting inclusion

criteria were enrolled with a target sample size of 50 over

12 months, after institutional ethics approval and written

informed consent.

Inclusion Criteria:

Presumed first-episode ACS patients (MI diagnosed by

history, ECG, and enzymes), age > 18 years, of both

sexes.

Exclusion Criteria:

Chronic stable angina; previous PCI/CABG; significant

valvular heart disease; chronic kidney dis-ease (eGFR <

60 mL/min/1.73 m2); chronic atrial fibrillation;

suspected/confirmed pulmonary embolism; pulmonary

hypertension; corpulmonale; viral

myocarditis/pericarditis/cardiomyopathy; malignancy or

anemia.

Treatment and Investigations:

All patients received guideline-directed medical therapy.

Eligible patients without contraindications to fibrinolysis

received tenecteplase per weight-based dosing. Coronary

angiography was per-formed per standard protocol. Two-

dimensional echocardiography was performed within 48

hours of admission. LV systolic function was assessed by

Simpson’s disc method, and regional wall motion

abnormalities were recorded. Patients were classified by

LAVI: Group A (LAVI > 34 mL/m2) and Group B (LAVI

≤ 34 mL/m2).

Endpoints:

Primary endpoint: cardiovascular death.

Secondary endpoint: MACE (repeat hospitalization for

heart failure, in-stent restenosis, re-infarction, target

vessel revascularization, repeat revascularization, atrial

fibrillation, or ischemic stroke).

Statistical Analysis:

SPSS v23.0 was used. Independent t-tests and ANOVA

were applied as appropriate. ROC anal-ysis assessed cut-

off values, sensitivity, specificity, and predictive values.

Pearson correlation assessed associations between

LAVI/LA strain and E/e′; p < 0.05 was considered

significant.

RESULTS:

The mean age was 62 ± 6.7 years; 56% were male.

Common comorbidities included hypertension (56%),

diabetes (54%), and dyslipidemia (32%). Presentations

were NSTEMI (46%), STEMI (40%), and unstable

angina (14%). MACE occurred in 13 patients (26%),

including 2 deaths, 5 heart failure hospitalizations, 2 atrial

fibrillation events, 3 revascularizations for recurrent chest

pain, and 1 CABG.

LAVI and LA strain showed significant differences

between patients with and without MACE at 6 and 12

months (both p < 0.05), while associations at presentation

were not significant.

3D-style colorful charts:

Figures 2 and 3 are 3D-style charts created from the

summary statistics in the manuscript (not raw patient-

level data). Replace with exported SPSS charts if desired.

IJMSCRR: May-June, 2026 Page | 249

DISCUSSION:

This single-center prospective cohort suggests that follow-

up measures of LA size and deformation (LAVI and LA

strain) are associated with MACE after ACS. Because LA

dysfunction can precede structural enlargement, strain-

based assessment may provide complementary

information to volumetric indices, particularly during

post-ACS follow-up.

CONCLUSION:

In this cohort, LAVI and LA strain at follow-up (6 and 12

months) were associated with MACE, while baseline

values had limited discriminatory power. Larger

multicenter studies are warranted to clarify optimal cut-

offs and clinical integration.

Limitations:

Single-center design and modest sample size. LA volume

was calculated using a two-dimensional method, which

may be less accurate than three-dimensional approaches in

the setting of complex LA geometry.

Ethical Approval:

The study was approved by the Institutional Ethics

Committee of IPGMER & SSKM Hospital, Kolkata.

Written informed consent was obtained from all

participants.

Conflict of Interest:

The authors declare no conflict of interest.

Funding:

No external funding was received.

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