Introduction:
Atrial fibrillation (AF) progression has been associated with asymmetric left atrial (LA) dilatation and left ventricular diastolic dysfunction (LVDD). LVDD has been also correlated with symptom severity.
Hypothesis:
Aim of this study was to test the hypothesis that the pattern of LA asymmetry is associated to LVDD and symptom severity.
Methods:
In 104 patients (58±10 years old, 69% male) referred for AF ablation, CT data were used to determine the LA volume (LAV) after exclusion of the appendage and the pulmonary veins (PVs). A cutting plane, between the PV ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA (LA-P) parts. The ratio LA-A/LAV was defined as asymmetry index (ASI). LVDD was evaluated according to current guidelines and symptom severity was quantified using the European Heart Rhythm Association score.
Results:
Univariate linear regression revealed that ASI is associated with LVDD, LAV and mitral regurgitation. ASI was higher in patients with LVDD (n=35, 62±5% vs. 59±6%, p=0.013) and in patients with mitral regurgitation (n=67, 61±6% vs. 58±5%, p=0.025) than those without. LAV increase was associated with an ASI increase (r=0.26, p=0.008). Multiple linear regression analysis revealed that LAV (β=0.211, 95% CI: 0.003-0.071, p=0.033) and LVDD (β=0.207, 95% CI: 0.167-5.011, p=0.036) were the only independent predictors of ASI increase (adjusted r2=0.92, F=6.2, p=0.003). Patients with moderate-severe AF symptoms (n=61) had higher ASI (61±6% vs. 58±5%, p=0.012) and higher prevalence of LVDD (43% vs. 21%, p=0.034) than those with mild symptoms.
Conclusions:
LA symmetry changes are associated with dilatation and left ventricular diastolic dysfunction and correlate with symptom severity in AF.
Left Ventricular Diastolic Dysfunction Is Associated With the Prevalence of Paroxysmal Atrial Fibrillation Determined on the Latest Echocardiographic Criteria
