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Original article
Left atrial minimum volume and reservoir function as correlates of left ventricular diastolic function: impact of left ventricular systolic function
  1. Cesare Russo1,
  2. Zhezhen Jin2,
  3. Shunichi Homma1,
  4. Tatjana Rundek3,4,5,
  5. Mitchell S V Elkind6,
  6. Ralph L Sacco3,4,5,
  7. Marco R Di Tullio1
  1. 1Department of Medicine, Columbia University Medical Center, New York, New York, USA
  2. 2Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
  3. 3Department of Neurology, Miller School of Medicine, University of Miami, Florida, USA
  4. 4Department of Epidemiology, Miller School of Medicine, University of Miami, Florida, USA
  5. 5Department of Human Genetics, Miller School of Medicine, University of Miami, Florida, USA
  6. 6Department of Neurology, Columbia University Medical Center, New York, New York, USA
  1. Correspondence to Professor Marco R Di Tullio, Division of Cardiology, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, PH3-342, New York, NY 10032, USA; md42{at}columbia.edu

Abstract

Objective Left atrial (LA) maximum volume (LAVmax) is an indicator of left ventricular (LV) diastolic function. However, LAVmax is also influenced by systolic events, whereas the LA minimum volume (LAVmin) is directly exposed to LV pressure. The authors hypothesised that LAVmin may be a better correlate of LV diastolic function than LAVmax.

Design Cross-sectional.

Setting University hospital.

Patients 357 participants from a community-based cohort study.

Methods LA volumes and reservoir function, measured as total LA emptying volume (LAEV) and LA emptying fraction (LAEF), were assessed by real-time three-dimensional echocardiography. LV diastolic function was assessed by trans-mitral early (E) and late (A) Doppler velocities and mitral early diastolic velocity by tissue-Doppler (e'). LV systolic function was assessed by LV ejection fraction (LVEF) and global longitudinal strain (GLS) by speckle-tracking.

Results LAVmin significantly increased with worsening diastolic dysfunction (p<0.001), whereas the increase in LAVmax was less pronounced (p=0.07). LAEV and LAEF decreased with worsening diastolic dysfunction (both p<0.001). In linear regressions, LAVmin and LAVmax were significant predictors of E/e', with higher parameter estimates for LAVmin. In multivariate models, LAVmin resulted strongly associated with E/e' (β=0.45, p<0.001), whereas LAVmax was not (β=−0.16, p=0.08). LA reservoir function was better associated with GLS than LVEF. In multivariate analyses, GLS was significantly associated with LAVmax (β=−0.15, p=0.002), LAEV (β=−0.37, p<0.001) and LAEF (β=−0.28, p<0.001) but not with LAVmin.

Conclusions LAVmin is a better correlate of LV diastolic function than LAVmax. The impact of LV longitudinal systolic function on LA reservoir function might explain the weaker relation between LAVmax and LV diastolic function.

  • Left atrium
  • diastole
  • systole
  • three-dimensional echocardiography
  • speckle-tracking echocardiography
  • echocardiography
  • cardiac function
  • diastolic dysfunction
  • systolic dysfunction
  • three dimensional
  • echocardiography (transoesophageal)
  • cardiac ultrasound
  • stroke

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Footnotes

  • Funding This work was supported by the National Institute of Neurological Disorders and Stroke (grant number R01 NS36286 to MDT and R37 NS29993 to RLS/MSE).

  • Competing interests None.

  • Ethics approval The ethics approval was provided by Columbia University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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