Left atrial systolic force and cardiovascular outcome. The Strong Heart Study.
BACKGROUND
The force needed to fill the left ventricle (LV) in late diastole (left atrial systolic force [LASF]) is abnormal in diseased hearts. The goal of this study was to determine whether LASF adds to prognostic prediction of other markers of preclinical cardiovascular disease in a population with a high prevalence of hypertension and diabetes.


METHODS
Doppler echocardiography was performed on 2808 participants of the Strong Heart Study (age 59.3 +/- 8.0 years, 62.5% women, 43.0% hypertensive, 46.7% diabetic, and 54.1% obese) without valvular abnormalities or previous cardiovascular events. The LASF was estimated from mitral orifice area and mitral peak A velocity.


RESULTS
The LASF was correlated with older age, higher BP, body mass index, creatinine, serum glucose, insulin levels, and heart rate. After controlling for clinical covariates, LASF was independently associated with higher LV dimensions, LV mass, stroke volume, and cardiac output (all P < .01). In Cox regression analysis, greater LASF was associated with a higher rate of CV events (HR = 1.033, 95% CI = 1.005 to 1.061; P = .021), independently of demographic characteristics, risk factors, LV geometry, and transmitral diastolic pattern.


CONCLUSIONS
In a population-based sample of middle-aged and elderly adults with a high prevalence of hypertension and diabetes and without prevalent cardiovascular disease, LASF was associated with geometric changes of the heart and with increased rate of combined fatal and nonfatal cardiovascular events.
Chinali
Marcello
M
Department of Medicine, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York 10021, USA.
de Simone
Giovanni
G
Roman
Mary J
MJ
Bella
Jonathan N
JN
Liu
Jennifer E
JE
Lee
Elisa T
ET
Best
Lyle G
LG
Howard
Barbara V
BV
Devereux
Richard B
RB
D016279:Atrial Function, Left / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology* / Q000503:physiopathology; D048909:Diabetes Complications / Q000453:epidemiology / Q000503:physiopathology; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012044:Regression Analysis; D013318:Stroke Volume; D013599:Systole