P268Best determinants of left atrial function are left ventricular longitudinal systolic function and arterial stiffness


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Abstract

Interaction between ventricular and arterial function, “ventriculo-arterial coupling”, was studied extensively. However, left atrial (LA) function, part of this continuum, was ignored, mainly because is difficult to assess it.Methods: We studied 80 subjects (44±18 years, 43 men) from a large clinical spectrum: 20 athletes, 20 normals, 20 patients with risk factors, and 20 with dilated cardiomiopathy, with an ejection fraction (EF) from 12 to 76%. LA reservoir function was assessed from total LA strain (TLAS), while LA conduit function from passive atrial EF (PAEF); LV global systolic function from EF; longitudinal systolic function from global longitudinal strain (GLS), mean 6 basal segments systolic velocity (S'), mean systolic mitral annular velocity (Sa), and mean MAPSE; LV diastolic function from E/Vp, mean 6 basal segments diastolic velocity (E'), and mean mitral annular diastolic velocity (Ea). Arterial function from intima-media thickness (IMT) and stiffness parameters (Ep and local wave speed - LWS); endothelial function from flow mediated dilation (FMD).Results: LA reservoir function (TLAS) correlated positively with LV longitudinal, both systolic and diastolic functions (table). Meanwhile, TLAS correlated inversely with arterial stiffness and positively with endothelial function. PAEF correlated with LV relaxation, arterial stiffness, and endothelial function. By stepwise multiple regression analysis, best determinants of LA reservoir function were LV longitudinal (GLS) and arterial functions (LWS): r=0.78, r2=0,53; and of LA conduit function were Ea and E/Vp: r=0.78, r2=0,61 (all p=0.001). Conclusion. LA function is mainly determined by LV longitudinal function and arterial stiffness. This should be taken into account when targeting atrial-ventriculo-arterial coupling by medication.

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