Left atrial minimal volume: association with diastolic dysfunction and heart failure in patients in sinus rhythm or atrial fibrillation with preserved ejection fraction

• Published in: BMC medical imaging Vol. 21; no. 1; pp. 76 - 10
• Main Authors: Ben-Arzi, Assaf, Hazanov, Evgeni, Ghanim, Diab, Rozen, Guy, Marai, Ibrahim, Grosman-Rimon, Liza, Kachel, Erez, Amir, Offer, Carasso, Shemy
• Format: Journal Article
• Language: English
• Published: London BioMed Central 06.05.2021; BioMed Central Ltd; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Aortic Valve - diagnostic imaging; Aortic Valve - physiology; Area Under Curve; Assessments; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Function, Left - physiology; Cardiac arrhythmia; Cardiac patients; Cardiovascular diseases; Case-Control Studies; Congestive heart failure; Diagnosis; Diastole - physiology; Diastolic dysfunction; Dyspnea; Dyspnea - epidemiology; Dyspnea - physiopathology; Echocardiography; Echocardiography - methods; Edema; Ejection fraction; Female; Fibrillation; Health risks; Heart; Heart Atria - diagnostic imaging; Heart failure; Heart Failure, Diastolic - diagnostic imaging; Heart Failure, Diastolic - physiopathology; Heart Rate - physiology; Heart Ventricles - diagnostic imaging; Humans; Hypertension; Imaging; Left atrial volumes; Male; Mechanics; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiology; Multivariate Analysis; Preserved ejection fraction; Pulmonary hypertension; Radiology; Research Article; Respiration; Retrospective Studies; Rhythm; Risk analysis; Risk Factors; Sinuses; Statistical analysis; Stroke Volume - physiology; Thoracic imaging; Variables; Variance analysis; Ventricle; Ventricular Function, Left - physiology; Young Adult; Heart failure; Diastolic dysfunction; Preserved ejection fraction; Left atrial volumes; Atrial fibrillation
• ISSN: 1471-2342; 1471-2342
• DOI: 10.1186/s12880-021-00606-3

Background Evidence of diastolic dysfunction (DD) required for the diagnosis of heart failure with preserved ejection fraction (HFpEF) is elusive in atrial fibrillation (AF). Left ventricular (LV) and left atrial (LA) speckle-tracking echocardiography (STE) may provide rhythm independent indications of DD. We aimed to find common LV/LA myocardial mechanics parameters to demonstrate DD, using STE in patients with AF. Methods 176 echocardiographic assessments of patients were studied retrospectively by STE. 109 patients with history of AF were divided in three groups: sinus with normal diastolic function (n = 32, ND), sinus with DD (n = 35, DD) and patients with AF during echocardiography (n = 42). These assessments were compared to 67 normal controls. Demographic, clinical, echocardiographic and myocardial mechanic characteristics were obtained. Results The patients with DD in sinus rhythm and patients with AF were similar in age, mostly women, and had cardiovascular risk factors as well as higher dyspnea prevalence compared to either controls or patients with ND. In the AF group, LV ejection fraction (LVEF) ( p  = 0.008), global longitudinal strain and LA emptying were lower ( p  < 0.001), whereas LA volumes were larger ( p  < 0.001) compared to the other groups. In a multivariable analysis of patients in sinus rhythm, LA minimal volume indexed to body surface area (Vmin-I) was found to be the single significant factor associated with DD (AUC 83%). In all study patients, Vmin-I correlated with dyspnea (AUC 80%) and pulmonary hypertension (AUC 90%). Conclusions Vmin-I may be used to identify DD and assist in the diagnosis of HFpEF in patients with AF.