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Published on: December 13, 2019
[Value of left atrial area index for diagnosing left ventricular diastolic dysfunction in hypertensive patients with
Wei-hong Li1, Zhao-ping Li, Xin-heng Feng
1Department of Cardiology, Peking University Third Hospital, Beijing, China.
Insights
Left atrium dilation is linked to higher left ventricular filling pressure in hypertensive patients with preserved ejection fraction. Left atrial area index (LAAI) effectively identifies diastolic dysfunction.
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- Hypertension often leads to diastolic dysfunction.
- Preserved ejection fraction (LVEF) can mask underlying diastolic abnormalities.
- Left atrial (LA) size is a potential indicator of diastolic dysfunction.
Purpose of the Study:
- To examine the relationship between LA size and left ventricular filling pressure (LVFP).
- To assess the utility of LA size measurements in detecting diastolic dysfunction in hypertensive patients with preserved LVEF.
Main Methods:
- Echocardiography was performed on 346 hypertensive patients with LVEF ≥ 50%.
- Left atrial diameter (LAD) and area (LAA) were measured, indexed to body surface area (LADI, LAAI).
- LVFP was calculated using the E/Em ratio; patients were classified into diastolic dysfunction (DD) and normal diastolic function (NDF) groups.
Main Results:
- Patients with DD exhibited significantly larger LA size (LADI, LAAI) compared to the NDF group (P < 0.01).
- LA size parameters positively correlated with LVFP (r = 0.211-0.450, P < 0.01).
- Left atrial area index (LAAI) showed the strongest correlation with LVFP (r = 0.450, P < 0.01).
Conclusions:
- Left atrial dilation is positively associated with LVFP in hypertensive patients with preserved LVEF.
- LAAI is a valuable and accurate parameter for identifying diastolic dysfunction in this patient population.
Objective:
To investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography.
Methods:
Echocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265).
Results:
As compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%.
Conclusion:
Left atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.
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