Worsening diastolic dysfunction was associated with increased left atrial volume index, with grade II and grades III-IV DD associated with 24% and 62% larger LA volumes, respectively (p<0.0001).
Cross-Sectional (n=2,042)
Is diastolic dysfunction associated with left atrial enlargement and mortality in the general population?
Diastolic dysfunction is strongly associated with left atrial remodeling and serves as a stronger independent predictor of mortality than left atrial volume in the general population.
Effect estimate: 24% larger for grade II, 62% larger for grade III-IV
p-value: p=<0.0001
OBJECTIVES: We examined the association between diastolic function and left atrial volume indexed to body surface area (LAVi) in a population-based study. BACKGROUND: Atrial enlargement has been suggested as a marker of the severity and duration of diastolic dysfunction (DD). However, the association between DD and atrial enlargement and their individual prognostic implications in the population is poorly defined. METHODS: A cross-sectional sample of Olmsted County, Minnesota, residents > or =45 years of age (n=2,042) underwent comprehensive Doppler echocardiography and medical record review. RESULTS: The LAVi increased with worsening DD: 23 +/- 6 ml/m2 (normal), 25 +/- 8 ml/m2 (grade I DD), 31 +/- 8 ml/m2 (grade II DD), 48 +/- 12 ml/m2 (grades III to IV DD). In bivariate analyses, age, left ventricular mass index, and DD grade were positively associated, whereas female gender and ejection fraction (EF) were inversely associated with LAVi (p <0.001 for all). When controlling for age, gender, cardiovascular (CV) disease, EF, and left ventricular mass, grade II DD was associated with a 24%, and grade III to IV DD was associated with a 62% larger LA volume (p <0.0001 for both). The area under the receiver-operator characteristic curve for LAVi to detect grade I, grade II, or grade III to IV DD was 0.57, 0.81, and 0.98, respectively. Both DD and LAVi were predictive of all-cause mortality, but when controlling for DD, LAVi was not an independent predictor of mortality. CONCLUSIONS: These data suggest that DD contributes to LA remodeling. Indeed, DD is a stronger predictor of mortality; presumably it better reflects the impact of CV disease within the general population.
Pritchett et al. (2004) conducted a cross-sectional in Diastolic dysfunction (n=2,042). Diastolic dysfunction vs. Normal diastolic function was evaluated on Left atrial volume indexed to body surface area (LAVi) (24% larger for grade II, 62% larger for grade III-IV, p=<0.0001). Worsening diastolic dysfunction was associated with increased left atrial volume index, with grade II and grades III-IV DD associated with 24% and 62% larger LA volumes, respectively (p<0.0001).