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Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden

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Abstract

Left ventricular (LV) diastolic dysfunction is prevalent in the community. Current assessment of diastolic function can be complex, involving Doppler evaluation of an array of hemodynamic data. The relation between left atrial (LA) volume and diastolic function, and between LA volume and cardiovascular risk and disease burden are not well known. In the present prospective study of 140 adults, mean age 58 ± 19 years, referred for a clinically-indicated echocardiogram and in sinus rhythm, with no history of atrial arrhythmias or valvular heart disease, we determined the LA volume, LV diastolic function status, cardiovascular risk score (based on age, gender, history of systemic hypertension, diabetes mellitus, hyperlipidemia, and smoking), and cardiovascular disease burden (based on confirmed vascular disease, congestive heart failure, and transient ischemic attack or stroke). LA volume was found to correlate positively with age, body surface area, cardiovascular risk score, LV end-diastolic and end-systolic dimensions, LV mass, diastolic function grade, tissue Doppler E/E′, tricuspid regurgitation velocity, and negatively with LV ejection fraction (all p <0.006). In a multivariate clinical model, LA volume indexed to body surface area (indexed LA volume) was independently associated with cardiovascular risk score (p <0.001), congestive heart failure (p = 0.014), vascular disease (p = 0.012), transient ischemic attack or stroke (p = 0.021), and history of smoking (p = 0.008). In a clinical and echocardiographic model, indexed LA volume was strongly associated with diastolic function grade (p <0.001), independent of LV ejection fraction, age, gender, and cardiovascular risk score. In patients without a history of atrial arrhythmias or valvular heart disease, LA volume expressed the severity of diastolic dysfunction and provided an index of cardiovascular risk and disease burden.

Section snippets

Study subjects and data acquisition:

After approval from the Mayo Clinic Institutional Review Board, patients who had met all study criteria were invited to participate. Eligible patients were adults ≥18 years of age referred for a standard clinically-indicated outpatient transthoracic echocardiogram who were in sinus rhythm, and had no history of atrial arrhythmia, valvular heart disease, congenital heart disease, or permanent pacemaker implantation. Atrial arrhythmia was defined to include atrial fibrillation, atrial flutter,

Relation of LA volume to LV diastolic function profile and filling pressures:

The study population consisted of 140 adult patients (70 men), mean age 58 ± 19 years (range 18 to 90), who were referred for echocardiography because of the following reasons: dyspnea (35%); chest pain (25%); palpitations, dizziness, presyncope, or syncope (5%); murmurs (4%); assessment of LV function (15%); and leg edema, pulmonary pressures, and other nonspecific reasons (16%). The baseline clinical and echocardiographic characteristics of the population are listed in Table 2.

Multiple

Discussion

In the present study of patients without valvular heart disease or history of atrial arrhythmias, LA volume reflects the severity of diastolic dysfunction. Abnormal LV relaxation and decreased compliance occur as a consequence of altered actin–myosin interactions and increased collagen deposition or cross-linking with changes of cardiac viscoelastic properties.16 During diastole, the left atrium is directly exposed to pressures in the left ventricle that increase with decreased LV compliance.

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