Relationship Between Left Atrial Volume and Diastolic Dysfunction in 500 Brazilian Patients

Abstract

BackgroundLeft atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). ObjectiveTo evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. MethodsWe have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. ResultsMean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m2 (absent), 26 ± 7 mL/m2 (grade I), 33 ± 5 mL/m2 (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. ConclusionDD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples

“…Besides, the elevated LV filling pressure in AF patients, which was estimated by E/e', was also found to be independently associated with atrial remodeling [33]. Therefore, the elevation of LV filling pressure was a good explanation for the increase in LA dimension and volume after LAAC in this study [34][35][36]. Further analysis with multivariable regression showed that the change of LV filling pressure in LAAC group, represented by the E/e' ratio, was independently associated with LVPWd (β = -2.23, p < 0.01, R = 0.477) (Fig.…”

Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

“…In a greater cohort study – PREVEND - an analysis has been made for the causes of HFpEF occurring within the period of 11 years, the investigation showed that the advanced age, urinary albumin excretion, cystatin C and a history of atrial fibrillation were strongly indicated by occurrence of HFpEF. In the past two decades, the percent of the patients with preserved ejection fraction increased from 38% to 54% of all the cases with hearth failure and this percent was considered to increase progressively with aging of the population and with the increase of the prevalence of patients with hypertension, obesity and diabetes [ 2 , 9 ].…”

“…LC is disturbed by diseases which disturb the energetic metabolism of calcium re-uptake such as myocardial ischemia and myocardial hypertrophy [ 6 ]. Aging, on its own, is directly connected with cardiac contractile dysfunction, which is manifested with prolonged time duration of the left chamber relaxation and stress intolerance [ 9 ]. It is proved, in trials, that aging, on its own, leads to diastolic dysfunction, oxidative stress and protein modification [ 9 ].…”

Диастолическая Дисфункция: От Открытия До Последних Обновлений

“…Nowadays, the term "diastolic dysfunction" is in use. Diastole is disturbed also in systolic HF and considered to be more stressing with further worsening of exercise intolerance and determines the prognosis and systolic contraction disturbances, so HF is a common entity with both phenotypes [4,5] The signs of myocardial DD are detected in people with almost any heart disease. Thus, in patients with arterial hypertension (AH), left ventricular diastolic dysfunction (LVDD) occurs in 50-90 % of cases and closely correlates with the degree of increase in blood pressure (BP) and AH presence.…”