Left atrial remodeling in patients younger than 70 years with diastolic and systolic heart failure.
OBJECTIVE
We sought to determine left atrial (LA) volume and systolic function (LA remodeling) in younger (<70 years) patients with systolic and diastolic heart failure (HF).


METHODS
In all, 32 patients with diastolic HF (left ventricular [LV] ejection fraction > or = 0.50), 26 patients with systolic HF (LV ejection fraction < 0.50), and 48 control subjects were studied. LAlpha volume (cm(3)/m(2)) was echocardiographically determined at mitral valve opening (maximal), mitral valve closure (minimal), and atrial systole (electrocardiographic Rho wave) using the biplane area-length method. The LA active emptying fraction (%) and ejection force (kdyne/m(2)) served as indices of LA systolic function.


RESULTS
LA maximal volume was greater in systolic HF than diastolic HF and in the latter greater than control (68.6 +/- 13.8 vs 52 +/- 11.6 vs 42.9 +/- 14.4, respectively, P < .0001). Active emptying fraction was similar between diastolic HF and control, and greater than systolic HF (31.5 +/- 8.1 vs 36.3 +/- 7 vs 26.6 +/- 6.2, respectively, P < .0001), whereas LA ejection force was similar in diastolic and systolic HF and greater than control (5.05 +/- 1.3 vs 4.98 +/- 2.17 vs 3.63 +/- 2.05, respectively, P = .001). Vmax was related to body surface area, brain natriuretic peptide, and LV mass in diastolic HF (multiple R2 = 0.74) and to diastolic blood pressure, LV mass, and early to late transmitral flow velocity ratio in systolic HF (multiple R2 = 0.96).


CONCLUSIONS
LA remodeling is more severe in systolic HF than diastolic HF and governed by different mechanisms. This may be of significant clinical relevance regarding the morbidity and mortality of these two conditions.
Triposkiadis
Filippos
F
Department of Cardiology, Larissa University Hospital, Larissa, Greece. admin@triposkiadis.com <admin@triposkiadis.com>
Harbas
Christos
C
Kelepeshis
Glafkos
G
Sitafidis
George
G
Skoularigis
John
J
Demopoulos
Vasilios
V
Tsilimingas
Nikolaos
N
D003971:Diastole; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging*; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013599:Systole; D014463:Ultrasonography