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This is a Cross-Sectional Study study.

September 23, 2025Open Access

P19 - Reevaluation of diastolic dysfunction in obese individuals: can indexed left atrial enlargement and reduced atrial strain redefine diastolic dysfunction?

Key Points

A substantial number of obese individuals show signs of left atrial enlargement and impaired atrial strain, indicating subclinical diastolic dysfunction.
While only 34% met conventional criteria for diastolic dysfunction, 62.7% exhibited left atrial enlargement using indexed measures.
The study highlights the importance of using indexed left atrial volume metrics for better identification of diastolic dysfunction in the obese population.
Indexing left atrial volume by height or height squared may provide earlier detection of diastolic dysfunction than current guidelines allow.

Abstract

Abstract Background The link between obesity and heart failure is well-established. Obesity is associated with diastolic dysfunction (DD), making heart failure with preserved ejection fraction (HFpEF) a more prevalent condition. However, DD in obese individuals may be underrecognized when conventional diagnostic criteria are used. Left atrial enlargement (LAE) is a fundamental diagnostic hallmark of DD. Impaired myocardial deformation (strain) of the left atrium (LA) often precedes overt DD. This study aimed to assess the prevalence of LAE and impaired LA strain in obese individuals. Methods A cross-sectional study was conducted in 126 subjects aged 45.0 ± 9.6 years, categorized into 4 groups: Group 1 – overweight (BMI 25-29.9 kg/m2); Group 2 – class I obesity (BMI 30-34.9 kg/m2); Group 3 – class II obesity (BMI 35–39.9 kg/m2); and Group 4 – class III obesity (BMI 40 kg/m2). All subjects underwent transthoracic echocardiography to assess LAE and LA functional remodeling using 2D speckle-tracking echocardiography. Diastolic function was classified according to current ASE/EACVI guidelines. We indexed the left atrial volume (LAV) using body surface area (LAVI), as well as height (LAVh) and height squared (LAVh). Results Only 34% of the cohort fulfilled conventional echocardiographic criteria for DD. However, LAE was detected in 62.7% of participants using LAVh2, 40.5% using LAVh, and 11.9% using LAVI. There was a progressive significant increase in the prevalence of LAVh and LAVh2 in obese groups, with the highest prevalence among those with class III obesity (p=0.002, p=0.002, respectively). LA strain parameters—peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS)—were reduced compared to reference values (30.96 ± 9.39% and 16.31 ± 5.55%, respectively). Subjects with class III obesity also exhibited the greatest metabolic derangements, waist circumference, and duration of obesity. Conclusion A substantial proportion of individuals classified as having “normal” diastolic function by guideline criteria demonstrated LAE and impaired LA strain, suggesting subclinical DD. Indexing LA volume by height or height squared, rather than by body surface area, may allow earlier detection and potential reclassification of DD in obese population. These findings support the use of refined LA assessments to improve cardiovascular risk stratification in obesity.

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