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. 2024 Apr 17;2(1):qyae028.
doi: 10.1093/ehjimp/qyae028. eCollection 2024 Jan.

Left atrial to ventricular volume ratio and relation to fitness, cardiovascular risk factors, and diastolic function in healthy individuals: the HUNT Study

Sigbjorn Sabo  1   2 , Havard Dalen  1   2 , John Nyberg  1 , Bjørnar Leangen Grenne  1   2 , Even Olav Jakobsen  1   2 , Bjarne Martens Nes  1   2 , Ulrik Wisløff  1   3 , Jon Magne Letnes  1   2
Affiliations

Left atrial to ventricular volume ratio and relation to fitness, cardiovascular risk factors, and diastolic function in healthy individuals: the HUNT Study

Sigbjorn Sabo et al. Eur Heart J Imaging Methods Pract. .

Abstract

Aims: Left atrial (LA) and ventricular (LV) remodelling is thought to be balanced in healthy individuals, and the LA end-systolic volume (LAV) to LV end-diastolic volume (LVEDV) ratio (LA:LV) could help discriminate between pathological and physiological LA enlargement. We aimed to assess LA:LV and its associations with age, sex, and cardiovascular risk factors HbA1C, body mass index (BMI), systolic blood pressure, and peak oxygen uptake (VO2peak). The association to measures of LV diastolic function and filling pressures were compared with LAV and LA reservoir strain.

Methods and results: Cardiopulmonary exercise testing and measurement of risk factors 10 years apart and echocardiography at follow-up was performed in 1348 healthy adults [52% women, mean (SD) age 59 (12) years] prospectively included in a large population study. All risk factors were significantly associated with LA:LV in univariate analyses, while BMI and VO2peak were significantly associated with LA:LV in adjusted models. A higher LA:LV was associated with increased odds ratio (OR) of diastolic dysfunction [OR (95% CI) 2.6 (2.1, 3.3)]. Measures of LV filling pressures were more closely associated with LA:LV than LAV and LA reservoir strain, but LA reservoir strain was more closely related to some diastolic function measures. In individuals with LAV > 34 mL/m2, the LA:LV explained 29% of variance in VO2peak (P < 0.001).

Conclusion: A higher LA:LV was associated with, and may improve, assessment of diastolic dysfunction and filling pressures. The LA:LV differentiates VO2peak in individuals with enlarged LAV and may have a role in evaluating whether LA enlargement reflects pathology.

Keywords: cardiopulmonary exercise testing; diastolic dysfunction; left atrial volume.

Plain language summary

The size of the left forechamber, also known as the left atrium, is used as a criterion when looking for signs of heart failure. However, an enlarged left atrium is also commonly found in healthy individuals with hearts adapted to exercise training. In the healthy state, both the forechambers and the main chambers (ventricles) are thought to adapt together and enlarge in a balanced way. Therefore, we explored whether an enlarged ratio between the left atrium and the left ventricle was more tightly related to other signs of maladaptation than left atrial size alone. Our results show that the left atrial to ventricular ratio may have a role in distinguishing heart failure from healthy adaptation.

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Conflict of interest statement

Conflict of interest Institutional partnership with GE Ultrasound in the Centre for Innovative Ultrasound Solutions. H.D. has a research contract with GE Ultrasound and has received consulting fees and/or honoraria from Boehringer Ingelheim, Bristol Myers Squibb, Bayer, and Pfizer. None of the disclosures were related to this work. The remaining authors have nothing to disclose.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Flowchart of the study sample. *Fitness Study participants were recruited from the HUNT3 baseline study (2006–08) with 50 807 participants.
Figure 2
Figure 2
Standardized LAV, LVEDV, LA:LV, and VO2peak vs. age. LAV, Left atrial end-systolic volume; LVEDV, Left ventricular end-diastolic volume; LA:LV ratio, LAV:LVEDV ratio; VO2peak, absolute peak oxygen uptake.
Figure 3
Figure 3
LAV, LVEDV, and LV mass without indexing and indexed against BSA and VO2peak. BSA, body surface area; LAV, left atrial volume; LV, left ventricle; LVEDV, left ventricular end-diastolic volume.
See this image and copyright information in PMC

References

    1. Blume GG, Mcleod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PMet al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr 2011;12:421–30. - PubMed
    1. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJet al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006;47:2357–63. - PubMed
    1. Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RHet al. Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. Am J Cardiol 2014;113:1394–400. - PubMed
    1. Vaziri SM, Larson MG, Lauer MS, Benjamin EJ, Levy D. Influence of blood pressure on left atrial size. Hypertension 1995;25:1155–60. - PubMed
    1. Keren G, Etzion T, Sherez J, Zelcer AA, Megidish R, Miller HIet al. Atrial fibrillation and atrial enlargement in patients with mitral stenosis. Am Heart J 1987;114:1146–55. - PubMed

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