title: Left atrial volume predicts abnormal exercise left ventricular filling pressure.
abstract: OBJECTIVE
  Latent heart failure at rest can be observed in a number of patients upon exercise. Considering left atrial (LA) remodelling as the reflection of the cumulative effects of the LV filling pressure (FP) over time, our aim was to investigate whether the LA volume would predict abnormal exercise LVFP.
  
  
  RESULTS
  Ninety patients (58.6 ± 10.8 years, 74 men) underwent exercise echocardiography. The LA maximal volume was measured by the Simpson method and indexed to body surface area. LVFP was assessed by the ratio between early peak diastolic velocities of mitral inflow and the septal annular mitral plane (E/e'). Exercise E/e' >13 was used as a threshold to define abnormal LVFP. Indexed LA volume was correlated with E/e' at rest (r = 0.37, P = 0.003), but the correlation was better with exercise E/e' (r = 0.54, P < 0.0001). In multivariate analysis, age, LV end-diastolic volume index, LVEF, and exercise E/e' were the independent determinants of LA volume index (R(2)  = 0.47, P < 0.0001). Eleven patients had exercise E/e' >13; compared with the rest of the population, these patients were older and achieved a milder effort. LA volume index >33 mL/m(2) predicted an abnormal exercise LVFP with a 91% sensitivity and a 78% specificity. None of the patients with an LA volume index <26 mL/m(2) (n = 31, 34%) had an exercise E/e' >13.
  
  
  CONCLUSIONS
  Exercise LVFP is a determinant of LA size. LA volume index seems to be helpful for predicting abnormal exercise LVFP. The potential use of LA remodelling to identify the patients benefitting most from exercise echocardiography should be investigated in larger studies.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France; University Paris VI, Faculté de Médecine Pierre et Marie Curie, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
authors.forename: Nadjib
authors.initials: N
authors.lastname: Hammoudi
authors.forename: Marc
authors.initials: M
authors.lastname: Achkar
authors.forename: Florent
authors.initials: F
authors.lastname: Laveau
authors.forename: Lila
authors.initials: L
authors.lastname: Boubrit
authors.forename: Morad
authors.initials: M
authors.lastname: Djebbar
authors.forename: Yann
authors.initials: Y
authors.lastname: Allali
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Richard
authors.initials: R
authors.lastname: Isnard
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D001794:Blood Pressure; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D062072:Patient Acuity; D011237:Predictive Value of Tests; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
keywords: Diastolic stress; Echocardiography; Exercise; LA volume; LV filling pressure; Left atrium