What is the clinical evidence from this study?

Study design: Observational. Population: Left Atrial Enlargement (n=90). Intervention: Body Mass Index vs. Lower Body Mass Index. Primary outcome: Left Atrial Enlargement (>4.0 cm in transverse dimension) (OR 1.08, 95% CI 1.01 to 1.15, p=0.02).

January 1, 2011Open Access

Higher Body Mass Index is an Independent Predictor of Left Atrial Enlargement

PKPrasanna Venkatesh KumarMayo Clinic AMAman MundiLouisiana State University Health Sciences Center Shreveport GCGloria CalditoLouisiana State University

Key Result

Higher body mass index is an independent predictor of left atrial enlargement, with every unit increase in BMI resulting in an 8% increase in the odds of having LAE (OR 1.08).

Study Design

Type

Observational (n=90)

Multicenter

Structured PICO

Does higher body mass index predict left atrial enlargement in patients undergoing echocardiography?

Population

90 adult patients with available echocardiographic data were retrospectively analyzed to determine if body mass index is an independent predictor of left atrial enlargement.

Exposure

Higher Body Mass Index (BMI)

Comparator

Lower Body Mass Index

Outcome

Left atrial enlargement (LAE) defined as >4.0 cm in transverse dimension by M-modesurrogate

Higher body mass index is an independent predictor of left atrial enlargement, increasing the odds by 8% per unit increase in BMI.

Main Result

Odds Ratio: 1.08 (95% CI 1.01–1.15)

p-value: p=0.02

Limitations

Retrospective design
Small number of patients
Non-randomized nature of the study
Non-homogeneity of the population
Possibility of selection bias

Abstract

Background: The influence of obesity on the cardiac geometry is less clear. Our objective was to determine if body mass index (BMI) was an independent predictor of left atrial enlargement (LAE) relative to LV thickness, dimension and function. Methods: Retrospective analysis of 90 consecutive patients with available echocardiographic data was performed. Patients were categorized into those with LAE (defined as >4.0 cm in transverse dimension by M-mode, n = 36) and those with normal LA size (n = 54). The clinical and echocardiographic variables were compared between the two groups. Results: Compared to patients with normal LA size, patients with LAE had significantly higher BMI (32 ± 8 vsi ± 8, p = 0.006), greater LV thickness, increased LV cavity dimension, and depressed LV systolic function. BMI was a strong and independent predictor of LAE. Left ventricular thickness and LV end-diastolic (LVED) dimension were other independent predictors of LAE. After adjusting for the significant effects of LV thickness and LV diameter, every unit increase in BMI resulted in an 8% increase in the odds of having LAE. Conclusions: 1) Higher BMI is an independent predictor of LAE. 2) Presence of LV enlargement and LV systolic dysfunction in these patients suggests that in the face of higher BMI, cardiac workload may exceed the compensatory LV hypertrophy and 3) LAE may be a consequence of the greater force developed by the LA to fill the LV.

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