title: Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors?
abstract: Increased left atrial volume (LAV) predicts a higher incidence of cardiovascular events and is widely recognized as a major surrogate marker of left ventricular (LV) diastolic dysfunction (DD). Although the pathophysiology of LA enlargement is probably multifactorial, few studies have examined comprehensively the clinical factors that lead to LA enlargement in the absence of valvular disease or LV systolic dysfunction. Therefore, we investigated associations between LAV and several clinical and echocardiographic parameters including DD.
  
  
  
  We enrolled 557 subjects without significant valve disease or LV systolic dysfunction from the health check-up clinic retrospectively. We performed univariable and multivariable linear regression using lnLAV index as the dependent variable and the following independent variables: gender, age, smoking status, drinking habit, hypertension, diabetes, body mass index (BMI), LV ejection fraction, DD, LV mass index, hemoglobin, serum creatinine, serum total cholesterol, serum uric acid, serum sodium, and serum iron.
  
  
  
  In multivariable analysis, LAV index was independently associated with BMI, lower hemoglobin, and moderate and severe DD compared with normal diastolic function (p<0.001), but not with mild DD (p=0.70).
  
  
  
  LA enlargement was independently associated with moderate and severe DD, but not with mild DD. Furthermore, obesity and lower hemoglobin were associated with LAV independently of DD.
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Seitetsu L
authors.initials: SL
authors.lastname: Lee
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan; Department of Clinical Laboratory, the University of Tokyo, Tokyo, Japan. Electronic address: daimon@muf.biglobe.ne.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan; Department of Clinical Laboratory, the University of Tokyo, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.affiliation: Department of Biostatistics, the University of Tokyo, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawata
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Hirokawa
authors.affiliation: Department of Clinical Laboratory, the University of Tokyo, Tokyo, Japan; Heart Center, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Systems, the University of Tokyo, Tokyo, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Clinical Laboratory, the University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yatomi
authors.affiliation: Clinical Research Support Center, the University of Tokyo, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology
chemical_list: D006454:Hemoglobins
keywords: Echocardiography; Left atrium; Obesity; Remodeling; Risk factors