The alterations of left atrial functional parameters in high left atrial volume index and diastolic dysfunction

Abstract

Purpose: Previous studies have shown the relationship between left ventricular diastolic dysfunction (DD) and left atrial volume index (LAVi). However, limited studies have been reported have been reported on the relationship of functional parameters of left atrium (LA) with LAVi and DD. Therefore, we aimed to examine the changes of functional parameters of LA in high LAVi and DD in this study.
Materials and methods: Transthoracic echocardiography was performed in 81 healty subjects (LAVi<30 ml/m2) and 81 patients with DD (LAVi>30 ml/m²). Maximum, minimum and preatrial volumes were measured using area-length method. The functional parameters of LA and other parameters including miyocardial performance index (MPI), left ventricular mass index, relative wall thickness, max LAVi/A’, LA sphericity index, the total atrial conduction time (PA-TDI) were calculated and DD was determined by using transmitral and pulmoner ven inflow, pulsed wave Doppler and tissue Doppler.
Results: Initially; max LAVi, min LAVi, preA LAVi, max LAVi/A’, LA sphericity index, LA total emptying volume (EV) index, LA active EV index, LA passive EV index, PA-TDI, left ventricular relative wall thickness, left ventricular mass index and MPI were significantly higher in patients with DD and high LAVi (p<0.05). The groups had similar total LA emptying fraction (LAEF) when age difference was removed with Ancova test analysis. LA expansion index decreased with age in patients with DD and high LAVi in correlation analysis (r=-0.408, p<0.001).
Conclusion: Max LAVi, min LAVi, preA LAVi, max LAVi/A’, LA sphericity index, LA total EV index, LA active EV index, LA passive EV index, PA-TDI, relative wall thickness, left ventricular mass index and MPI were higher in DD and high LAVi regardless of age. Although LA expansion index and total LAEF did not show significant alterations until 57 years in healthy subjects in this study, both of them may decrease in patients with DD and high LAVi, especially in advanced ages, due to prolonged exposure to high filling pressure of left ventricle.

Keywords

• Diastolic dysfunction
• echocardiography
• functional parameters
• left atrial volume index

Yüksek sol atriyal hacim indeksi ve diyastolik disfonksiyonunda sol atriyum fonksiyonel parametrelerindeki değişiklikler

Abstract

Amaç: Önceki çalışmalar, sol ventrikül diyastolik disfonksiyon (DD) ile sol atriyal hacim indeksi (LAVi) arasındaki ilişkiyi göstermiştir. Bununla birlikte, sol atriyumun (LA) fonksiyonel parametrelerinin LAVi ve DD ile ilişkisi hakkında sınırlı sayıda çalışma bildirilmiştir. Bu nedenle, biz bu çalışmada yüksek LAVi ve DD'deki LA'nin fonksiyonel parametrelerindeki değişiklikleri incelemeyi amaçladık.
Gereç ve yöntem: 81 sağlıklı kişiye (LAVi <30 ml/m2) ve diyastolik disfonksiyonu olan 81 hastaya (LAVi>30 ml/m²) transtorasik ekokardiyografi yapıldı. Maksimum, minimum ve preatriyal hacimler alan-uzunluk yöntemi kullanılarak ölçüldü. LA'nin fonksiyonel parametreleri ve miyokardiyal performans indeksi (MPI), sol ventrikül kitle indeksi, rölatif duvar kalınlığı, maks LAVi / A', LA sferisite indeksi, toplam atriyal iletim süresi (PA-TDI) gibi diğer parametreler hesaplandı ve DD transmitral giriş, pulmoner ven girişi, pulse dalga (PW) Doppler ve doku Doppler (TDI) kullanılarak belirlendi.
Bulgular: Başlangıçta; maks LAVi, min LAVi, preA LAVi, maks LAVi/A ', LA sferisite indeksi, LA total boşalma hacmi (EV) indeksi, LA aktif EV indeksi, LA pasif EV indeksi, PA-TDI, sol ventriküler rölatif duvar kalınlığı, sol ventriküler kitle indeksi ve MPI, DD ve yüksek LAVi'li hastalarda anlamlı olarak daha yüksekti (p<0,05). Yaş farkı Ancova test analizi ile kaldırıldığında gruplar benzer toplam LAEF değerine sahipti. Korelasyon analizinde DD ve yüksek LAVi’si olan hastalarda LA genişleme indeksi yaşla birlikte azaldı (r=-0,408, p<0,001).

Sonuç: Maks LAVi, min LAVi, preA LAVi, maks LAVi/A ', LA sferisite indeksi, LA toplam EV indeksi, LA aktif EV indeksi, LA pasif EV indeksi, PA-TDI, rölatif duvar kalınlığı, sol ventriküler kitle indeksi ve MPI yaşa bakılmaksızın DD ve yüksek LAVi’si olan hastalarda daha yüksekti. Bu çalışmada sağlıklı kişilerde LA genişleme indeksi ve toplam LAEF, 57 yaşına kadar anlamlı değişiklikler göstermemekle birlikte her ikisi de DD'li ve yüksek LAVi'li hastalarda, özellikle ileri yaşlarda uzamış sol ventrikül yüksek dolum basıncına uzun süre maruz kalması nedeniyle azalabilir.

Keywords

• Diyastolik disfonksiyon
• ekokardiyografi
• fonksiyonel parametreler
• sol atriyal hacim indeksi

References

1. Malladi SR. Left atrial volume index (LAVI) in the evaluation of left ventricular diastolic dysfunction Journal of Evolution of Medical and Dental Sciences 2015;(4):15:2532-2539.
2. Douglas PS. The left atrium – A biomarker of chronic diastolic dysfunction and cardiovascular risk. JACC 2003; (42):1206-1207.
3. Simek CL, Feldman MD, Haber HL, Wu CC, Jayaweera AR, Kaul S. Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function. J Am Soc Echocardiogr 1995;8:37-47.
4. Stefanadis C, Dernellis J, Toutouzas P. A clinical apprise of left atrial function Eur Heart Jour 2001; 22:22-36.
5. Greenberg B, Chatterjee K, Parmley WW, Werner JA, Holly AN. The influence of left ventricular filling pressure on atrial contribution to cardiac output. Am Heart J 1979;98:742–751.
6. Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 2002;90:1284–1289.
7. European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure? European Heart J. 1998;19:990–1003.
8. Jiamsripong P, Honda T, Reuss CS, Hurst RD, Chaliki HP, Grill DE, et al. Three methods for evaluation of left atrial volume.European Journal of Echocardiography 2008;(9):351–355.

9. Lupu S, Mitre A, Dobreanu D. Left atrium function assessment by echocardiography – physiological and clinical implications. Med Ultrason 2014; 16(2):152-159.
10. Park HJ, Jung HO, Min J, Park MW, Park SC, Shin D, et al. Left atrial volume index over late diastolic mitral annulus velocity (LAVi/A') is a useful echo index to identify advanced diastolic dysfunction and predict clinical outcomes. Clin Cardiol 2011;34(2):124-130.
11. Badano LP, Miglioranza MH, Mihăilă S, Peluso D, Xhaxho J, Marra MP, et al. Left Atrial Volumes and Function by Three-Dimensional Echocardiography Reference Values, Accuracy, Reproducibility, and Comparison With Two-Dimensional Echocardiographic Measurements.Circ Cardiovasc Imaging. 2016;9:e004229. doi: 10.1161/circimaging.115.004229.
12. Bisbal F, Guiu E, Calvo N, Marin D, Berruezo A, Arbelo E, et al. Left Atrial Sphericity: A New Method to Assess Atrial Remodeling. Impact on the Outcome of Atrial Fibrillation Ablation. Journal of Cardiovascular Electrophysiology 2013;24(7):752–759.
13. Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi N, Nagase N, Ara N,et al. Association of left atrial reservoir function with left atrial structural remodeling related to left ventricular dysfunction in asymptomatic patients with hypertension: evaluation by two-dimensional speckle-tracking echocardiography. Clin Exp Hypertens 2015;37(2):155-165.
14. Antoni ML, Bertini M, Atary JZ, Delgado V, ten Brinke EA, Boersma E, et al. Predictive value of total atrial conduction time estimated with tissue Doppler imaging for the development of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol 2010;106(2):198-203.
15. Uluçay A, Tatli E. Myocardial performance index. Anadolu Kardiyol Derg 2008;8(2):143-148.
16. Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review.Journal of the American College of Cardiology 2019; 73(15): 1961-1977.
17. Russo C, Jin Z, Homma S, Rundek T, Elkind MSV, Sacco RL, et al. Left atrial minimum volume and reservoir function as correlates of left ventricular diastolic function: impact of left ventricular systolic function.Heart. 2012 May; 98(10): 813–820.
18. Iida M, Yamamoto M, Ishiguro Y, Yamazaki M, Ueda N, Honjo H, et al. Association of left atrial phasic volumes with systemic arterial stiffness and ankle– brachial index in hypertensive patients. J Hum Hypertens 2017;31(4):270-277.
19. van Heerebeek L, Paulus WJ. Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction SOJ Pharm Pharm Sci. 2014; 1(2),1-20.
20. De Vos CB, Weijs B, Crijns HJGM, Cheriex EC, Palmans A, Habets J, et al. Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart 2009;95(10):835-840.
21. Hsiao SH, Chiou KR. Diastolic Heart Failure Predicted by Left Atrial Expansion Index in Patients with Severe Diastolic Dysfunction. PLoS One 2016;11(9):e016259.
22. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013;62:263–271.
23. Boyd AC, Schiller NB, Leung D, Ross DL, Thomas L. Atrial Dilation and Altered Function Are Mediated by Age and Diastolic Function But Not Before the Eighth Decade. JACC: Cardiovascular Imaging 2011; (4):3: 234-242.
24. Spencer KT, Mor-Avi V, Gorcsan J, DeMaria A, Kimball T, Monaghan M, et al. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart 2001; 85:272–277.
25. Blume GG, Mcleod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM, et al. Left atrial function: physiology, assessment, and clinical implications. European Journal of Echocardiography 2011;12:421–430.
26. 26. Teo SG, Yang H, Chai P, Yeo TC. Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis.European Journal of Echocardiography 2010; 11(1):38-43.
27. 27. Kurt M, Wang J, Torre-Amione G, et al. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2:10-15.
28. 28. Thomas L, Levett K, Boyd A, Leung DYC, Schiller NB, Ross DL. Compensatory Changes in Atrial Volumes With Normal Aging: Is Atrial Enlargement Inevitable? Journal of the American College of Cardiology. J Am Coll Cardiol 2002;40:1630–1635.
29. 29. Melenovsky V, Borlaug BA, Rosen B, Hay I, Ferruci L, Morell CH, et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol. 2007; 49: 198–207.
30. 30. Cacciapuoti F, Scognamiglio A, Paoli VD, Romano C, Cacciapuoti F. Left Atrial Volume Index as Indicator of Left Ventricular Diastolic Dysfunction: Comparation between Left Atrial Volume Index and Tissue Myocardial Performance. Index J Cardiovasc Ultrasound 2012;20(1):25-29.