TY - JOUR
T1 - Relationship between left ventricular wall thickness and left atrial size
T2 - Comparison with other measures of diastolic function
AU - Simek, Christopher L.
AU - Feldman, Marc D.
AU - Haber, Howard L.
AU - Wu, Clarence C.
AU - Jayaweera, Ananda R.
AU - Kaul, Sanjiv
N1 - Funding Information:
Congestive heart failure in the presence of normal left ventricular (LV) systolic function has been rec- From the Cardiovascular Division, University of Virginia School of Medicine. Supported in part by grants from the National Institutes of Health, Bethesda, Maryland (R29-HL4704C and R01-HL48890d), and a grant-in-aid from the Virginia Affiliate of the American Heart Association, Glen Allen, Virginia.c bRecipient of a fellowshipt raining grant from the Virginia Affiliate of the American Heart Association, dEstablished Investigator of the American Heart Association, Dallas, Texas. Presented in part at the Third Annual Scientific Session of the American Society of Echocardiography, Boston, Massachusetts, Jtme 15-17, 1992. Reprint requests: Sanjiv Kaul, MD, CardiovascularD ivision, Box 158, Medical Center, University of Virginia, Charlottesville,V A 22908. Copyright 9 1995 by the American Societyo f Echocardiography. 0894-7317/95 $3.00 + 0 27/1/58096 ognized for several years. 1-3 These patients have increased left atrial (LA) pressure with normal LV ejection indexes, and the most common underlying disease is LV hypertrophy.l-6 The increased LA pressure in these patients with normal LV systolic function and no mitral valve disease has been attributed to LV diastolic dysfunction} 6 Based on our clinical experience, we hypothesized that in patients with essential hypertension, normal LV systolic function, and no evidence of any other cardiac disease, LA size would correlate with the degree of LV wall thickness: the greater the LV thickness, the larger would be the left atrium. We postulated that LA size would correlate with LV wall thickness by reflecting the chronicity and duration and thus the history of LA hypertension. Furthermore, unlike other hemodynamic and Doppler measures of LV diastolic dysfunction, LA size would not
PY - 1995
Y1 - 1995
N2 - We postulated that in patients with essential hypertension and normal left ventricular (LV) systolic function, left atrial (LA) size correlates with LV wall thickness by better reflecting the chronicity and duration of LA hypertension than the commonly used hemodynamic and Doppler measures of LV diastolic function. Accordingly, hemodynamic, Doppler, and two-dimensional echocardiographic measurements were performed in 30 subjects with no cardiovascular abnormalities other than essential hypertension (mean systolic blood pressure of 150±29 mm Hg). The mean LV wall thickness was 0.57±0.14 cm/m2 and the mean LV ejection fraction was 0.62±0.12. Hemodynamic and Doppler measures including pulmonary capillary wedge and LV end-diastolic pressures, isovolumic LV pressure relaxation, LV chamber elastic stiffness, and E/A ratio (E and A waves on the pulsed Doppler signal of the mitral valve) correlated poorly (r=0.01 to -0.52) with LV wall thickness. Both E/A ratio and isovolumic LV pressure relaxation correlated better (p=0.05) with patient age than with LV wall thickness. In contrast, LA area (in the apical four-chamber view) had a good correlation (r=0.77 for LA area in atrial diastole and r=0.86 for LA area in atrial systole) with LV wall thickness. Multiple regression analysis revealed LA area in atrial systole to be the best correlate of LA wall thickness. We conclude that because the left atrium is a thin-walled structure, its size may increase with an increase in LA pressure. In the absence of mitral valve disease and atrial fibrillation, LA size may reflect the chronicity and duration and thus the history of LA hypertension. LA size in the apical four-chamber view may, therefore, provide a simple noninvasive assessment of the degree of LV diastolic dysfunction.
AB - We postulated that in patients with essential hypertension and normal left ventricular (LV) systolic function, left atrial (LA) size correlates with LV wall thickness by better reflecting the chronicity and duration of LA hypertension than the commonly used hemodynamic and Doppler measures of LV diastolic function. Accordingly, hemodynamic, Doppler, and two-dimensional echocardiographic measurements were performed in 30 subjects with no cardiovascular abnormalities other than essential hypertension (mean systolic blood pressure of 150±29 mm Hg). The mean LV wall thickness was 0.57±0.14 cm/m2 and the mean LV ejection fraction was 0.62±0.12. Hemodynamic and Doppler measures including pulmonary capillary wedge and LV end-diastolic pressures, isovolumic LV pressure relaxation, LV chamber elastic stiffness, and E/A ratio (E and A waves on the pulsed Doppler signal of the mitral valve) correlated poorly (r=0.01 to -0.52) with LV wall thickness. Both E/A ratio and isovolumic LV pressure relaxation correlated better (p=0.05) with patient age than with LV wall thickness. In contrast, LA area (in the apical four-chamber view) had a good correlation (r=0.77 for LA area in atrial diastole and r=0.86 for LA area in atrial systole) with LV wall thickness. Multiple regression analysis revealed LA area in atrial systole to be the best correlate of LA wall thickness. We conclude that because the left atrium is a thin-walled structure, its size may increase with an increase in LA pressure. In the absence of mitral valve disease and atrial fibrillation, LA size may reflect the chronicity and duration and thus the history of LA hypertension. LA size in the apical four-chamber view may, therefore, provide a simple noninvasive assessment of the degree of LV diastolic dysfunction.
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U2 - 10.1016/S0894-7317(05)80356-6
DO - 10.1016/S0894-7317(05)80356-6
M3 - Article
C2 - 7710749
AN - SCOPUS:0029179695
SN - 0894-7317
VL - 8
SP - 37
EP - 47
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 1
ER -