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Left Atrial Volume Determinants in Patients with Non-Ischemic Dilated Cardiomyopathy
Frederico José Neves Mancuso1, Valdir Ambrósio Moisés1, Dirceu Rodrigues Almeida1
1Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, BR.
Insights
Left atrial volume (LAV) in dilated cardiomyopathy (DCM) is independently determined by left ventricular (LV) filling pressures and mitral regurgitation. These factors are key to understanding prognosis in heart failure patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left atrial volume (LAV) is a significant prognostic indicator in patients diagnosed with heart failure.
- Dilated cardiomyopathy (DCM) is a common cause of heart failure, characterized by left ventricular (LV) dysfunction.
Purpose of the Study:
- To investigate the primary determinants of left atrial volume (LAV) in patients suffering from dilated cardiomyopathy (DCM).
- To identify echocardiographic parameters that independently predict LAV in DCM patients.
Main Methods:
- Ninety DCM patients with LV ejection fraction ≤ 0.50 underwent real-time three-dimensional echocardiography (3D echo).
- Evaluated parameters included LV volumes, ejection fraction, mitral inflow, tissue Doppler, E/e' ratio, dyssynchrony indices, and mitral regurgitation.
- Pearson's correlation and multiple linear regression analyses were employed to determine significant predictors of LAV.
Main Results:
- Significant correlations were found between LAV and LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, E wave, E/e' ratio, and mitral regurgitation.
- Multivariate analysis revealed the E/e' ratio (p=0.02) and mitral regurgitation (p=0.02) as independent predictors of increased LAV.
Conclusions:
- Left atrial volume (LAV) in DCM is independently influenced by LV filling pressures, as indicated by the E/e' ratio.
- Mitral regurgitation is also a significant independent determinant of LAV in DCM patients.
- These findings highlight critical echocardiographic markers for assessing prognosis in DCM.
Background:
Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.
Objective:
We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM).
Methods:
Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e' wave, E/e' ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson's coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables.
Results:
Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e' ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e' ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase.
Conclusion:
The LAV is independently determined by LV filling pressures (E/e' ratio) and mitral regurgitation in DCM.
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