Left Atrial Volume, Cardiorespiratory Fitness, and Diastolic Function in Healthy Individuals: The HUNT Study, Norway
Jon Magne Letnes1,2, Bjarne Nes1,2, Kristina Vaardal-Lunde3
1Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.
Insights
In healthy adults, higher cardiorespiratory fitness (CRF) is linked to larger left atrial (LA) size, independent of diastolic dysfunction. This suggests LA size in fit individuals reflects fitness, not disease.
Area of Science:
- Cardiology
- Exercise Physiology
- Echocardiography
Background:
- Left atrial (LA) size and cardiorespiratory fitness (CRF) predict cardiovascular events.
- LA dilatation is a criterion for diastolic dysfunction, but also seen in athletes.
- The association between CRF and LA size in healthy individuals is unclear.
Purpose of the Study:
- To investigate the association between LA size, CRF, and physical activity in healthy adults.
- To determine if LA size is associated with echocardiographic indexes of left ventricular diastolic dysfunction in this population.
Main Methods:
- Cross-sectional study using data from the HUNT study (107 men, 138 women, aged 20-82).
- Assessed LA volume indexed to body surface area (LAVI) via echocardiography.
- Measured CRF as peak oxygen uptake (VO2peak) and calculated physical activity levels.
Main Results:
- Left atrial volume index (LAVI) was positively associated with VO2peak and physical activity.
- LAVI was not associated with indexes of left ventricular diastolic dysfunction.
- An interaction between age and CRF indicated larger LAVI with increasing age and higher CRF.
Conclusions:
- LA size interpretation as diastolic dysfunction marker should consider age-relative CRF.
- Further research is needed on the prognostic value of LAVI in physically fit populations.
Abstract:
Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO2peak) using ergospirometry, and percent of age- and-sex-predicted VO2peak was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m2 in 39% of participants, and LAVI was positively associated with VO2peak and percentage of age- and-sex-predicted VO2peak (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO2peak/percentage of age- and-sex-predicted VO2peak showing higher LAVI with advanced age and higher VO2peak/percentage of age- and-sex-predicted VO2peak as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.
