OBESITY-RELATED CHANGES IN DIASTOLIC FUNCTION AND LEFT ATRIAL IN PATIENTS WITH RECURRENT ATRIAL FIBRILLATION AND PRESERVED EJECTION FRACTION: DOES GENDER MATTER?

Abstract

Objective: Both diastolic dysfunction (DD) and left atrial (LA) remodeling are closely associated with each other as well as with atrial fibrillation (AF) and heart failure with preserved ejection fraction. Obesity was traditionally considered to be a state of chronic volume overload, neurohumoral activation and, therefore, heart remodeling. But the data concerning relationship between obesity, DD and LA remodeling depending on gender is scarce. We aimed to evaluate the impact of gender on the association between body mass index (BMI), the presence of obesity and DD, LA remodeling in patients with recurrent AF, hypertension and preserved ejection fraction. Design and method: Twenty seven men and 28 women (median age of 65 [60;72]) with recurrent AF, hypertension and preserved ejection fraction (>50%) were enrolled in this study. Beyond conventional echocardiographic protocol, global peak LA longitudinal strain (PALS, %) in the reservoir (r) and contractile (c) phases was measured using two-dimensional speckle tracking echocardiography. Results: There were no significant differences between women and men in most clinical and demographic parameters including, duration of hypertension (65 vs 67 moths, respectively; p = 0.88) and AF (37 vs 42 moths, respectively; p = 0.83). DD was significantly more pronounced in women [E/E’ (13 vs 11.2; p = 0.03), but both groups had similar LA-volume index (41 vs 41 ml/m2; p = 0.97), PALSr (12.6 vs 12.4% p = 0.64) and PALSc (-12.9 vs -12.4% p = 0.65). Women, but not men, had significant association between BMI and PALSc (r = 0.6; p < 0.001 vs r = 0.2; p = 0.24), E’ (r = -0.41; p = 0.03 vs r = -0.04; p = 0.84); interaction p for PALSc = 0.043 and for E’ = 0.1. Only in women subgroups of patients with and without obesity differed by LA size (45 vs 36 mm p = 0.006), PALSr (11.7 vs 14.8% p = 0.03), PALSc (-12.5 vs -16.2% p = 0.002) and E’ (0.05 vs 0.07 m/s p = 0.02). Conclusions: Patients of both genders had similar patterns of LA remodeling. But only in women was diastolic relaxation and left atrial structural and functional parameters significantly related to BMI and the presence of obesity. It might indicate a higher susceptibility of the women's heart to remodeling associated with overweight.