title: Left atrial minimum volume and reservoir function as correlates of left ventricular diastolic function: impact of left ventricular systolic function.
abstract: OBJECTIVE
  Left atrial (LA) maximum volume (LAV(max)) is an indicator of left ventricular (LV) diastolic function. However, LAV(max) is also influenced by systolic events, whereas the LA minimum volume (LAV(min)) is directly exposed to LV pressure. The authors hypothesised that LAV(min) may be a better correlate of LV diastolic function than LAV(max).
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  357 participants from a community-based cohort study.
  
  
  METHODS
  LA volumes and reservoir function, measured as total LA emptying volume (LAEV) and LA emptying fraction (LAEF), were assessed by real-time three-dimensional echocardiography. LV diastolic function was assessed by trans-mitral early (E) and late (A) Doppler velocities and mitral early diastolic velocity by tissue-Doppler (e'). LV systolic function was assessed by LV ejection fraction (LVEF) and global longitudinal strain (GLS) by speckle-tracking.
  
  
  RESULTS
  LAV(min) significantly increased with worsening diastolic dysfunction (p<0.001), whereas the increase in LAV(max) was less pronounced (p=0.07). LAEV and LAEF decreased with worsening diastolic dysfunction (both p<0.001). In linear regressions, LAV(min) and LAV(max) were significant predictors of E/e', with higher parameter estimates for LAV(min). In multivariate models, LAV(min) resulted strongly associated with E/e' (β=0.45, p<0.001), whereas LAV(max) was not (β=-0.16, p=0.08). LA reservoir function was better associated with GLS than LVEF. In multivariate analyses, GLS was significantly associated with LAV(max) (β=-0.15, p=0.002), LAEV (β=-0.37, p<0.001) and LAEF (β=-0.28, p<0.001) but not with LAV(min).
  
  
  CONCLUSIONS
  LAV(min) is a better correlate of LV diastolic function than LAV(max). The impact of LV longitudinal systolic function on LA reservoir function might explain the weaker relation between LAV(max) and LV diastolic function.
authors.affiliation: Division of Cardiology, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D002306:Cardiac Volume / Q000502:physiology*; D003430:Cross-Sectional Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure