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 and N-terminal probrain sodium-uretic peptid level in patients with atrial fibrillation
