title: Left atrium measurement in patients suspected of having heart failure with preserved ejection fraction.
abstract: BACKGROUND
  The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained.
  
  
  OBJECTIVE
  To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients.
  
  
  METHODS
  This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex) suspected of having HF, divided into two groups: with HFPEF (n = 35) and without HFPEF (n = 107).
  
  
  RESULTS
  The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6.9 ± 2.0 cm/s vs. 9.3 ± 2.5 cm/s; p < 0.0001) and LV filling pressure (E/E' ratio: 15.2 ± 6.4 vs. 7.6 ± 2.2; p < 0.0001). The ILAV cutoff point of 35 mL/m² best correlated with the diagnosis of HFPEF, showing sensitivity, specificity, and accuracy of 83%. The ILAD cutoff point of 2.4 cm/m² showed sensitivity of 71%, specificity of 66%, and accuracy of 67%.
  
  
  CONCLUSIONS
  For diagnosing HFPEF in ambulatory patients, the ILAV proved to be a more accurate parameter than ILAD. On echocardiographic assessment, ILAV, rather than ILAD, should be routinely measured.
authors.affiliation: Universidade Federal Fluminense, Niterói, RJ. lagoeiro@cardiol.br
authors.forename: Antônio José Lagoeiro
authors.initials: AJ
authors.lastname: Jorge
authors.forename: Mario Luiz
authors.initials: ML
authors.lastname: Ribeiro
authors.forename: Maria Luiza Garcia
authors.initials: ML
authors.lastname: Rosa
authors.forename: Fernanda Volponi
authors.initials: FV
authors.lastname: Licio
authors.forename: Luiz Cláudio Maluhy
authors.initials: LC
authors.lastname: Fernandes
authors.forename: Pedro Gemal
authors.initials: PG
authors.lastname: Lanzieri
authors.forename: Bruno Afonso Lagoeiro
authors.initials: BA
authors.lastname: Jorge
authors.forename: Flavia Oliveira Xavier
authors.initials: FO
authors.lastname: Brito
authors.forename: Evandro Tinoco
authors.initials: ET
authors.lastname: Mesquita
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000009:adverse effects / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009929:Organ Size; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology