Mechanism of left a trial enlargement related to ventricular diastolic impairment in hypertension

Matsuda, Masako; Matsuda, Yasuo

doi:10.1002/clc.4960191211

Cited by 86 publications

(61 citation statements)

References 26 publications

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“…We think this explanation unlikely, however, given that the left atrium is typically enlarged in diastolic dysfunction with high, LV end-diastolic pressure. 25,[46][47][48] RV dilation with impingement on the LV is also an important consideration in states of very high pulmonary artery pressure, 15 which is unlikely in the present study of predominantly mild to moderate COPD. Smaller pulmonary vein dimensions were associated with reduced RV EDV.…”

Section: Discussionmentioning

confidence: 80%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

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Section: Discussionmentioning

confidence: 80%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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“…The association of the E/Em ratio, which reflects LV end diastolic pressure with LA size, supports the earlier concept and is in accordance with past reports. 28,29 From a clinical point of view, our findings suggest that LA diameter and volume can be used interchangeably for the evaluation of the relationship of LA size with LV geometry. Moreover, the authors confirmed the unequivocal role of LV hypertrophy in LA enlargement, strengthening the need for more aggressive and appropriate antihypertensive treatment, focusing on the substrate of both chambers.…”

Section: Discussionmentioning

confidence: 89%

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

et al. 2009

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We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m -2 , Po0.01 and 1.4 mm m -2 , P ¼ 0.003, respectively) or LV-CR (by 1.3 mm m -2 , P ¼ 0.003 and 1.6 mm m -2 , P ¼ 0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m -2 , Po0.001 and 3.4 ml m -2 , Po0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m -2 , respectively, Po0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

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“…Therefore, these pathological changes may be associated with lesser reverse remodeling of LA. According to previous studies, 23,24 insufficient LAVI regression in patients with HT is a consequence of impaired LV filling due to increased LV stiffness.…”

Section: Correlates Of Lavi and Lvmi Regressionsmentioning

confidence: 94%

Atrioventricular Reverse Remodeling After Valve Repair for Chronic Severe Mitral Regurgitation: 1‐Year Follow‐Up

Song

Jeon

et al. 2010

Clinical Cardiology

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Background: Chronic severe mitral regurgitation is associated with poor clinical outcome because chronic volume overload leads to hemodynamic changes and left ventricular and left atrial remodeling. Few data are available regarding left atrial volume index regression (LAVIR) and left ventricular mass index regression (LVMIR) after valve surgery for mitral regurgitation. We aimed to identify predictive correlates of LAVIR and LVMIR and to assess the relationship between these regressions. Hypothesis: Volume overload in chronic severe mitral regurgitation may influence left atrial and ventricular remodeling and reverse remodeling. Methods: Eighty-five patients who underwent valve repair for severe chronic mitral regurgitation were consecutively enrolled. Plasma N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and echocardiographic measurements were performed before surgery, before discharge, and at 12 months after surgery. LAVIR and LVMIR were assessed using serial echocardiography. Results: There were significant decreases in left ventricular mass index (LVMI; from 125.9 ± 31.3 g/m 2 to 94.8 ± 28.6 g/m 2 , P = 0.001) and left atrial volume index (LAVI; from 75.3 ± 33.5 mL/m 2 to 41.7 ± 16.0 mL/m 2 , P = 0.001) after surgery. Preoperative LAVI positively correlated with preoperative LVMI (r = 0.437, P = 0.001) and LAVIR positively correlated with LVMIR (r = 0.347, P = 0.001). In multivariate stepwise linear regression analysis, preoperative LAVI, age, hypertension, and atrial fibrillation were independently predictive of LAVIR, and preoperative LVMI, hypertension, and NT-proBNP were independently predictive of LVMIR.Conclusions: Volume overload in chronic severe mitral regurgitation may influence left ventricular remodeling and reverse remodeling, as well as left atrial remodeling and reverse remodeling. Preoperative lower LAVI, younger age, absence of hypertension, and absence of atrial fibrillation may predict LAVIR, and preoperative lower LVMI, lower NT-proBNP levels, and absence of hypertension may predict LVMIR after surgery for chronic severe mitral regurgitation.

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Mechanism of left a trial enlargement related to ventricular diastolic impairment in hypertension

Cited by 86 publications

References 26 publications

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

Atrioventricular Reverse Remodeling After Valve Repair for Chronic Severe Mitral Regurgitation: 1‐Year Follow‐Up

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