A Study on Evaluation of Relationship between Left Atrial Volume and Diastolic Dysfunction in Bangladeshi Patients

Abstract

Background: An increase in the left atrial volume index (LAVI) has been recognized as an important indicator of left ventricular (LV) diastolic dysfunction (DD), which is considered a significant risk factor for cardiovascular events. The left atrium plays a crucial role in maintaining efficient cardiac function by facilitating proper blood flow between the pulmonary veins and the left ventricle during diastole. Objective: In this study our main goal is to evaluate the relationship between Left Atrial Volume and Diastolic Dysfunction in 500 Bangladeshi Patients. Method: From January 2022 to January 2023, researchers at a tertiary hospital in Bangladesh analyzed data from 500 patients in need of a transthoracic echo in the cardiology department. Patients were people aged 20 to 86 with a history free of atrial or ventricular arrhythmias, pacemaker usage, valvular disease (other than minor), or congenital cardiopathy who presented with sinus rhythm. Forty-five people were left out because their tests were either too limited to assess mitral diastolic flow (n = 35) or too limited to assess left atrial volume index (n = 10). Five hundred patients were used as the study's final sample size. Results: The average age and proportion of men in the DD groups were both greater than in the normal function group. The DD groups had more left ventricular mass than the controls. Only in the group with ventricular filling limitation pattern (grade III DD), was the ejection fraction significantly decreased. LAVI and dimensions both rose as DD severity increased, from 21 4.2 mL/m2 in grade I to 26.1 7.5 mL/m2 in grade II to 50.4 2.8 mL/m2 in grade III (p 0.001). In addition, the grade I DD groups (altered relaxation) showed a relative decrease in the E-wave and the E/A ratio, and an increase in the mitral deceleration time, when compared to the normal diastolic function group; the opposite was seen in the group with grade III DD (restrictive pattern). All DD subtypes had weaker e' waves compared to those with normal diastolic function. As DD progressed, a rise in the E/e' ratio was seen. LAVI was positively correlated with age, left ventricular (LV) diastolic and systolic volumes, LV wall relative thickness, LV mass indexed to height raised to the 2.7th power, and E/e' ratio (all p 0.01). There was a statistically significant negative relationship between left atrial volume index and left ventricular ejection fraction, as well as between the e' wave and the septal mitral anulus. Conclusion: According to this study in a Bangladeshi population, DD contributes to left atrial remodelling, and a rise in LAVI is an indicator of DD severity. In this cohort with preserved or slightly reduced mean ejection fraction and no substantial valvular heart disease, LAVI increase determinants are related to age, left ventricular hypertrophy, higher filling pressure, and impaired LV systolic performance.