title: Left atrial volume is not an index of left ventricular diastolic dysfunction in patients with sickle cell anaemia.
abstract: BACKGROUND
  Left ventricular diastolic dysfunction (LVDD) is common in sickle cell anaemia (SCA). Left atrial (LA) size is widely used as an index of LVDD; however, LA enlargement in SCA might also be due to chronic volume overload.
  
  
  OBJECTIVE
  To investigate whether LA size can be used to diagnose LVDD in SCA.
  
  
  METHODS
  One hundred and twenty-seven adults with stable SCA underwent echocardiographic assessment. LA volume was measured by the area-length method and indexed to body surface area (LAVi). Left ventricular (LV) filling pressures were assessed using the ratio of early peak diastolic velocities of mitral inflow and septal annular mitral plane (E/e'). Using mitral inflow profile and E/e', LV diastolic function was classified as normal or abnormal. LAVi>28mL/m(2) was used as the threshold to define LA enlargement.
  
  
  RESULTS
  The mean age was 28.6±8.5years; there were 83 women. Mean LAVi was 48.3±11.1mL/m(2) and 124 (98%) patients had LA dilatation. In multivariable analysis, age, haemoglobin concentration and LV end-diastolic volume index were independent determinants of LAVi (R(2)=0.51; P<0.0001). E/e' was not linked to LAVi (P=0.43). Twenty patients had LVDD; when compared with patients without LVDD, they had a similar LAVi (52.2±14.7 and 47.5±10.2mL/m(2), respectively; P=0.29). Receiver operating characteristics curve analysis showed that LAVi could not be used to diagnose LVDD (area under curve=0.58; P=0.36).
  
  
  CONCLUSIONS
  LA enlargement is common in SCA but appears not to be linked to LVDD. LAVi in this population is related to age, haemoglobin concentration and LV morphology.
authors: Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, 75651 Paris, France; University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France; UMRS INSERM-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France. Electronic address: nadjib.hammoudi@psl.aphp.fr.
authors: Nadjib
authors: N
authors: Hammoudi
authors: Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75571 Paris, France.
authors: Magali
authors: M
authors: Charbonnier
authors: Public Health Department, Hôpital Tenon, AP-HP, Institut Pierre-Louis de Santé Publique, Inserm, UPMC-Paris 6, UMRS 1136, 75970 Paris, France.
authors: Pierre
authors: P
authors: Levy
authors: Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, 75651 Paris, France; University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France.
authors: Morad
authors: M
authors: Djebbar
authors: Department of Internal Medicine, Reference Centre for Adult Sickle Cell Disease, AP-HP, Tenon Hospital, 75970 Paris, France.
authors: Katia
authors: K
authors: Stankovic Stojanovic
authors: Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75571 Paris, France.
authors: Stéphane
authors: S
authors: Ederhy
authors: University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France; Department of Internal Medicine, Reference Centre for Adult Sickle Cell Disease, AP-HP, Tenon Hospital, 75970 Paris, France.
authors: Robert
authors: R
authors: Girot
authors: University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France; Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75571 Paris, France.
authors: Ariel
authors: A
authors: Cohen
authors: Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, 75651 Paris, France; University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France; UMRS INSERM-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France.
authors: Richard
authors: R
authors: Isnard
authors: University Paris 6, Faculté de Médecine Pierre-et-Marie-Curie, 75252 Paris, France; Department of Internal Medicine, Reference Centre for Adult Sickle Cell Disease, AP-HP, Tenon Hospital, 75970 Paris, France.
authors: François
authors: F
authors: Lionnet
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D006332:Cardiomegaly / Q000209:etiology* / Q000503:physiopathology; D003971:Diastole; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Anaemia; Anémie; Diastolic dysfunction; Drépanocytose; Dysfonction diastolique; LA remodelling; Left atrial volume; Remodelage OG; Sickle cell disease; Volume atrial gauche