Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-60s: data from the ACE 1950 Study

Rønningen, Peter Selmer; Berge, Trygve; Solberg, Magnar Gangås; Enger, Steve; Nygård, Ståle; Pervez, Mohammad Osman; Orstad, Eivind Bjørkan; Kvisvik, Brede; Aagaard, Erika Nerdrum; Røsjø, Helge; Tveit, Arnljot; Steine, Kjetil

doi:10.1093/ehjci/jeaa004

Cited by 20 publications

(12 citation statements)

References 42 publications

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“…We also found a higher correlation coefficient between NT-proBNP and LAVi min than LAVi max . However, as previously shown in our material,30 LAVi min has both higher intra-observer and inter-observer variability than LAVi max . Although this increased variability was not found in the study by Olsen et al ,10 the otherwise lack of normal values and less prospective data do not currently support the superior clinical usefulness of LAVi min compared with LAVi max .…”

Section: Discussionsupporting

confidence: 86%

Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes

Lyngbakken

Rønningen

Solberg

et al. 2022

Heart

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ObjectiveAtrial fibrillation is a common arrhythmia associated with risk of stroke, heart failure and death. We aimed to elucidate the associations of cardiac biomarkers, echocardiographic left atrial volumetric indices and risk of prevalent and incident atrial fibrillation in the general population.MethodsWe assessed cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), maximum (LAVimax) and minimum (LAVimin) indexed left atrial volumes and left atrial emptying fraction (LAEF) in subjects born in 1950 participating in the prospective observational cohort, Akershus Cardiac Examination 1950 Study. The Cohorts for Heart and Ageing Research in Genomic Epidemiology for Atrial Fibrillation risk score and sex was used to adjust for residual risk of atrial fibrillation.ResultsOut of 3487 subjects, 157 (4.5%) had prevalent and 123 (3.5%) had incident atrial fibrillation. Echocardiographic left atrial volumes and cardiac biomarkers associated with prevalent atrial fibrillation, but GDF-15 was non-significant in adjusted analysis. Incident atrial fibrillation was predicted by LAVimax(adjusted HR 1.51, 95% CI 1.30 to 1.75), LAVimin(adjusted HR 1.52, 95% CI 1.35 to 1.72), LAEF (adjusted HR 1.24, 95% CI 1.04 to 1.48) and NT-proBNP (adjusted HR 1.57, 95% CI 1.32 to 1.85). cTnT and NT-proBNP provided incremental prognostic information to left atrial volumes, but GDF-15 demonstrated no prognostic value for incident atrial fibrillation.ConclusionsIn the general population, echocardiographic left atrial volumetric indices and NT-proBNP, but not cTnT and GDF-15, associate with prevalent atrial fibrillation and with risk of incident atrial fibrillation. cTnT and NT-proBNP provide incremental prognostic information to echocardiography.

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Section: Discussionsupporting

confidence: 86%

Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes

Lyngbakken

Rønningen

Solberg

et al. 2022

Heart

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“…2,21 In contrast, age and endurance exercise are related to LA enlargement even in absence of LA disease. 22,23 Prevention of LA dysfunction and treatment of LA disease may therefore be of critical importance. The relationship between changes in LV structure and function and subsequent CV outcome is well established.…”

Section: Introductionmentioning

confidence: 99%

“…Recent data suggest that timely therapeutic intervention may attenuate the process of deleterious LA remodelling and potentially promote reverse LA remodelling with a consequent improvement in clinical symptoms and outcomes 2,21 . In contrast, age and endurance exercise are related to LA enlargement even in absence of LA disease 22,23 …”

Section: Introductionmentioning

confidence: 99%

Left atrial disease and left atrial reverse remodelling across different stages of heart failure development and progression: a new target for prevention and treatment

Bonelli

Cameli

Pagnesi

et al. 2022

European J of Heart Fail

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The left atrium is a dynamic chamber with peculiar characteristics. Stressors and disease mechanisms may deeply modify its structure and function, leading to left atrial remodelling and disease. Left atrial disease is a predictor of poor outcomes. It may be a consequence of left ventricular systolic and diastolic dysfunction and neurohormonal and inflammatory activation and/or actively contribute to the progression and clinical course of heart failure through multiple mechanisms such as left ventricular filling and development of atrial fibrillation and subsequent embolic events. There is growing evidence that therapy may improve left atrial function and reverse left atrial remodelling. Whether this translates into changes in patient's prognosis is still unknown. In this review we report current data about changes in left atrial size and function across different stages of development and progression of heart failure. At each stage, drug therapies, lifestyle interventions and procedures have been associated with improvement in left atrial structure and function, namely a reduction in left atrial volume and/or an improvement in left atrial strain function, a process that can be defined as left atrial reverse remodelling and, in some cases, this has been associated with improvement in clinical outcomes. Further evidence is still needed mainly with respect of the possible role of left atrial reverse remodelling as an independent mechanism affecting the patient's clinical course and as regards better standardization of clinically meaningful changes in left atrial measurements. Summarizing current evidence, this review may be the basis for further studies.

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“… 22 We have previously shown that in a healthy subgroup of this general population at ages 62 to 65 years, men had larger LA volumes indexed for body surface area compared with women. 23 However, most studies of normal LA volumes have not identified clinically significant differences between the sexes, and sex‐specific cutoffs have not been endorsed. 24 …”

Section: Discussionmentioning

confidence: 99%

Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid‐60s: Data From the ACE 1950 Study

Rønningen

Berge

Solberg

et al. 2022

JAHA

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Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure ( P =0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01555411.

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Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-60s: data from the ACE 1950 Study

Cited by 20 publications

References 42 publications

Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes

Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes

Left atrial disease and left atrial reverse remodelling across different stages of heart failure development and progression: a new target for prevention and treatment

Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid‐60s: Data From the ACE 1950 Study

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