CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Diastolic dysfunction and left atrial volume
A population-based study
Allison M. Pritchett, MD*,
Douglas W. Mahoney, MS ,
Steven J. Jacobsen, MD, PhD ,
Richard J. Rodeheffer, MD, FACC*,
Barry L. Karon, MD, FACC* and
Margaret M. Redfield, MD, FACC*,*
* Division of Cardiovascular Diseases, Department of Internal Medicine and the Divisions of
Clinical Epidemiology
Biostatistics, Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, Minnesota
Manuscript received May 3, 2004;
revised manuscript received September 7, 2004,
accepted September 14, 2004.
* Reprint requests and correspondence: Dr. Margaret M. Redfield, Guggenheim 9, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: redfield.margaret{at}mayo.edu).
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  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.
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Abbreviations and Acronyms
| | CV = cardiovascular | | DD = diastolic dysfunction | | EF = ejection fraction | | LA = left atrium/atrial | | LAVi = left atrial volume index | | LV = left ventricular | | LVMi = left ventricular mass index |
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