Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

Abstract

SummaryPrevious studies have examined the negative impacts of individual cardiovascular risk (CVR) factors on left atrial (LA)-left ventricular (LV) interaction, whereas the combined effects of these risk factors are insuffi ciently elucidated. We studied 176 asymptomatic patients with CVR factors and age-matched 50 healthy individuals by conventional and 2-dimensional speckle-tracking echocardiography. The patients were classifi ed into 2 groups according to the number of CVR factors: one risk factor (single) group (n = 79) and 2 or more risk factors (comorbid) group (n = 97). The peak early diastolic transmitral fl ow velocity (E)/peak early diastolic mitral annular motion velocity (e')/peak systolic LA strain (SLAs) was used as a surrogate for LA stiffness during ventricular systole. The E/e'/S-LAs was greatest in the comorbid group. The peak systolic LV circumferential and radial strains, peak early diastolic LV radial strain rate, and peak early diastolic LA strain and strain rate were lower in the comorbid group than in the single group. Multivariate regression analysis identifi ed age, body mass index, systolic blood pressure, end-systolic LV diameter, peak systolic mitral annular motion velocity (s'), and peak systolic LV radial strain in the comorbid group, and peak atrial systolic transmitral fl ow velocity and s' in the single group, as independent predictors of E/e'/S-LAs. Subtle LA and LV dysfunction with individual CVR factors were more aggravated with the comorbid conditions in asymptomatic patients. (Int Heart J 2014; 55: 138-145) Key words: LA diastolic stiffness, LA-LV interaction, 2-D speckle-tracking echocardiography I t is now recognized that approximately one-half of patients with the clinical syndrome of congestive heart failure (HF) have preserved systolic function, a condition referred to as HF with preserved ejection fraction (HFPEF). 1,2)The prevalence of this disease condition is anticipated to increase in elderly patients with cardiovascular risk (CVR) factors such as hypertension, diabetes, dyslipidemia, obesity, and smoking.2,3) Therefore, it is expected that a higher comorbid burden of the CVR factors is an important contributor to the development of HFPEF. Assessment of left atrial (LA) and left ventricular (LV) function, which we named as LA-LV interaction, 4) seems to have a clinical impact, because an abnormal LA-LV interaction is a mechanism responsible for producing congestion symptom. 4,5) However, few data are available on use and outcome studied with conventional echocardiography in the evaluation of LA-LV interaction in asymptomatic patients in the community. Angle-independent two-dimensional speckle-tracking echocardiography (2DSTE) has recently been introduced into clinical practice because it offers early detection of impaired LA reservoir function 6,7) and LV contraction and relaxation 8,9) in subclinical patients with CVR factors. We hypothesized that comorbid conditions of CVR factors would be associated with worse LA-LV interaction, probably providing a potent...

Left Ventricular Diastolic Function in Hypertension: Methodological Considerations and Clinical Implications

“…During this phase, the blood which had accumulated in the atrium while the valve was closed is poured rapidly into the ventricle, consequently the atrial pressure falls while the ventricular pressure increases. The contribution of rapid ventricular filling to total diastolic one, in healthy adults, is about 65-80% [ 21 ]. “Fast ventricular filling time” is a mainly passive process, due to the atrioventricular gradient, that is greatly influenced by ventricular compliance.…”

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

“…Hypertension is the common factor contributing to the development of HF, especially for the HF with preserved ejection fraction (HFpEF). Abnormality of LA-LV–arterial coupling is speculated to be related to development from hypertension to LV diastolic dysfunction and symptomatic HFpEF ( 31 , 33 ). In this study, abnormality of LA-LV–arterial coupling evaluated by 2DSTE-based strain combined with PWV, contributed to detect subclinical hypertensive cardiovascular dysfunction.…”

Factors Associated with Left Atrial Enlargement in Patients with Anemia Caused by Uterine Myoma

“…TDI allows the quantitative evaluation of myocardial function [26,27] and it is well known that TDI is more sensitive to detect subclinical abnormalities in systolic and diastolic LV function over conventional echocardiography [28,29]. Decreased S' velocity was well represent with subtle LA or LV dysfunction in asymptomatic individuals with cardiovascular risk factors [30].…”