Association of left atrial enlargement with left ventricular hypertrophy and diastolic dysfunction: A tissue Doppler study in echocardiographic practice

Figures & data

Table I. Demographic and clinical characteristics of the study population (n = 1104).

Parameters
Age (years)	58.3 ± 16.1
Men (%)	46.2
Clinic BP (mmHg)	134 ± 19/80 ± 10
Heart rate (beats/min)	72 ± 10
Body weight (kg)	72.1 ± 14.8
Height (cm)	163.4 ± 9.9
BSA (m^2)	1.77 ± 0.20
BMI (kg/m^2)	26.9 ± 4.8
Hypertension (%)	56.7
Obesity (%)	26.7
Current smokers (%)	16.7
Type 2 diabetes (%)	7.3
Elderly (>65 years) (%)	41.4
LV mass (g)	191 ± 58
LV mass index (g/height^2.7)	51 ± 15
LVH (%)	45.7
LA volume (ml)	33.9 ± 13.8
LA volume index (ml/m^2)	19.1 ± 7.5
LA enlargement (%)	9.6

Data are shown as means ± SD or percent; BP, blood pressure; BSA, body surface area; BMI, body mass index; LV, left ventricle; LA, left atrium; LVH, left ventricular hypertrophy.

Table II. Demographic and clinical characteristics of the study population categorized in quartiles of left atrium volume index (LAVI).

LAVI quartiles	I	II	III	IV	p
LAVI (ml/m^2)	5.6–13.9	14.0–17.9	18.0–22.8	22.9–62.6
Age (years)	54.4 ± 16.4	56.7 ± 15.9	56.9 ± 16.1	65.3 ± 13.8^a	<0.001
Gender (% men)	48.9	45.8	48.1	41.7	NS
BMI (kg/m^2)	26.0 ± 4.5	26.7 ± 4.7	26.6 ± 4.5	28.5 ± 5.2^a	<0.001
BSA (m^2)	1.78 ± 0.21	1.77 ± 0.20	1.77 ± 0.20	1.77 ± 0.21	NS
Clinic SBP (mmHg)	130 ± 17	133 ± 19	131 ± 18	142 ± 20^a	<0.001
Clinic DBP (mmHg)	80 ± 10	79 ± 10	80 ± 10	82 ± 11^a	<0.001
Heart rate (beats/min)	73 ± 10	73 ± 10	72 ± 10	71 ± 9	NS
Hypertension (%)	46.3	53.2	55.6	71.7^a	<0.01
Obesity (%)	19.2	25.3	24.2	36.6^a	<0.01
Current smoking (%)	19.9	16.6	17.4	13.1	NS
Type 2 diabetes (%)	5.8	6.8	6.5	10.1	NS
Elderly (>65 years) (%)	31.5	37.7	39.4	56.8^a	<0.01
Anti-hypertensive drugs (%)	42.0	47.8	53.9	72.8^a	<0.01
Lipid lowering drugs (%)	12.3	13.7	14.5	18.1	NS
Anti-P or anti-C drugs (%)	11.6	14.1	18.1	32.2^a	<0.01

Data are shown as means ± SD or percent, p-values by analysis of variance (continuous measures) or chi-square test (categorical variables). BMI, body mass index; BSA, body surface area; SBP, systolic blood pressure; DBP, diastolic blood pressure; P, platelets; C, coagulant. ^aIV vs I, II, III.

Table III. Echocardiographic variables of the study population categorized in quartiles of left atrium volume index (LAVI).

LAVI quartiles	I	II	III	IV	p
LAVI (ml/m^2)	5.6–13.9	14.0–17.9	18.0–22.8	22.9–62.6
LVIDd (mm)	45.8 ± 4.6	46.8 ± 4.4	47.3 ± 4.4	48.9 ± 4.4^a	<0.001
LVIDs (mm)	27.6 ± 4.4	27.7 ± 4.4	28.3 ± 4.4	28.9 ± 4.9^a	<0.001
IVSTd (mm)	9.9 ± 1.4	10.1 ± 1.5	10.2 ± 1.4	11.1 ± 1.6^a	<0.001
PWTd (mm)	8.9 ± 1.2	9.2 ± 1.3	9.2 ± 1.2	9.7 ± 1.2^a	<0.001
RWT	0.41 ± 0.05	0.41 ± 0.06	0.41 ± 0.05	0.43 ± 0.06^a	<0.001
LAD (mm)	34.1 ± 5.0	35.7 ± 5.4	36.9 ± 4.9	40.6 ± 5.3^a	<0.001
LADI (mm/m^2)	19.2 ± 2.6	20.3 ± 2.9	21.0 ± 2.7	23.0 ± 3.2^a	<0.001
AR (mm)	31.7 ± 4.1	32.4 ± 4.1	32.8 ± 4.0	33.7 ± 4.1^a	<0.001
LVM (g)	171.4 ± 51.3	184.2 ± 55.2	188.7 ± 49.8	220.4 ± 62.2^a	<0.001
LVMI (g/m^2.7)	43.9 ± 11.5	48.9 ± 14.3	49.9 ± 13.3	60.9 ± 15.7^a	<0.001
EF (%)	67.7 ± 5.3	67.3 ± 4.7	67.3 ± 5.7	66.6 ± 5.3	NS
E velocity (cm/s)	69.1 ± 16.9	69.6 ± 17.5	70.8 ± 16.7	73.8 ± 19.9^a	<0.001
A velocity (cm/s)	68.2 ± 19.0	73.4 ± 22.2	73.0 ± 20.6	82.2 ± 21.9^a	<0.001
E/A ratio	1.09 ± .41	1.04 ± 0.46	1.05 ± 0.40	0.96 ± 0.41^a	<0.001
DT (ms)	228 ± 54	227 ± 57	226 ± 63	234 ± 64^a	<0.001
Ei velocity (cm/s)	9.5 ± 3.3	8.8 ± .7	8.9 ± 3.4	7.7 ± 2.8^a	<0.001
Ai velocity (cm/s)	9.8 ± 2.3	9.8 ± 2.4	9.6 ± 2.3	9.6 ± 2.3	NS
Ei/Ai ratio	1.1 ± 0.66	1.0 ± 0.67	1.1 ± 0.61	0.89 ± 0.43^a	<0.001
E/Ei ratio	7.9 ± 2.7	8.9 ± 3.3	8.7 ± 2.8	10.5 ± 3.9^a	<0.001

LVIDd/s, left ventricular internal diameter diastole/systole; IVSTd, interventricular septum thickness diastole; PWTd, posterior wall thickness diastole; RWT, relative wall thickness; LAD, left atrium diameter; LADI, left atrium diameter index; AR, aortic root; LVM, left ventricular mass; LVMI, left ventricular mass index; EF, ejection fraction; E, early diastolic mitral flow velocity; A, late diastolic mitral flow velocity; DT, deceleration time; Ei, early annular velocity; Ai, late annular velocity. ^aIV vs III, II, I.

Figure 1. Prevalence of concentric (white bars) and eccentric (black bars) left ventricular hypertrophy (LVH) according to quartiles of left atrial volume index. *p < 0.01 IV vs III, II and I.

Figure 2. Prevalence of abnormal left ventricular (LV) relaxation and LV filling index according to quartiles of left atrial volume index. *p < 0.01 IV vs III, II, I.

Table IV. Clinical and echocardiographic correlates of left atrial volume index in the whole study population (n = 1104).

	Univariate		Multivariate
Variable	r	p	β	p
Age	0.28	<0.0001	0.188	<0.0001
BMI	0.16	<0.0001	0.086	<0.01
Clinic SBP	0.24	<0.0001	0.063	NS
Clinic DBP	0.07	0.02	0.019	NS
Clinic heart rate	−0.12	<0.0001	0.056	NS
EF	−0.15	<0.0001	0.021	NS
AR	0.17	<0.0001	0.026	NS
LVMI	0.43	<0.0001	0.408	<0.0001
RWT	0.11	<0.0001	0.068	NS
E/A ratio	0.09	0.003	0.002	NS
Ei velocity	0.20	<0.0001	0.104	0.01
DT	0.05	0.11	–	–
E/Ei	0.29	<0.0001	0.139	<0.0001

For abbreviations, see previous tables.