Key result
Left atrial enlargement is associated with significantly reduced reservoir and contractile functions, with total atrial strain decreasing from 21.74% in normal-sized atria to 17.75% in severe enlargement.
Why the study?
The exact relationship between left atrial size and phasic function, and whether left atrial dysfunction occurs before left atrial enlargement, have not been fully studied.
Does left atrial phasic function remodeling occur before left atrial enlargement in patients at high cardiovascular risk?
Cross-Sectional (n=715)
No
Does left atrial phasic function remodeling occur before left atrial enlargement in patients at high cardiovascular risk?
Left atrial phasic function remodeling, particularly impaired reservoir and conduit function, occurs prior to left atrial enlargement in high-risk patients, especially those with hypertension.
Answers are grounded in this paper and cite their sources.
May indicate early LA phasic remodeling before enlargement in hypertension; hypothesis-generating, warranting longitudinal confirmation.
BACKGROUND: Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atrial thought to represent a "dysfunctioning" atrium, since there is no accepted 'gold' standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physical deformation. MATERIALS AND METHODS: A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain = Sa + Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between subgroups in normal LA size with and without hypertension (HT). RESULTS: With LAE (from normal size, mild, moderate to severe LAE), the Stot (21.74 ± 5.97, 20.75 ± 4.99, 20.49 ± 5.27, 17.75 ± 4.71, respectively, ANOVA P = 0.003) and Sa (11.84 ± 3.92, 11.00 ± 3.29, 10.11 ± 2.57, 8.55 ± 2.88, respectively, ANOVA P < 0.001) reduced while Se had no change. Stot of Severe LAE group was significantly lower than that of Normal LA size group (P = 0.002). Sa of the three LAE groups were all significantly lower than that of Normal LA size group (P = 0.024, P = 0.002, P < 0.001, respectively). In normal sized LA subgroups, Stot (21.35 ± 5.91 vs. 23.01 ± 6.02, P = 0.008) and Se (9.51 ± 4.41 vs. 11.17 ± 4.89, P < 0.001) reduced in subjects with HT comparing with those without. CONCLUSION: LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.
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Chen et al. (2022) conducted a cross-sectional in High risk of cardiovascular disease (n=715). Left atrial enlargement vs. Normal left atrial size was evaluated on Total atrial strain (Stot) representing reservoir function (p=0.002). Left atrial enlargement is associated with significantly reduced reservoir and contractile functions, with total atrial strain decreasing from 21.74% in normal-sized atria to 17.75% in severe enlargement.
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