The impact of cardiovascular risk factors on left atrial strain over a decade

Abstract

Abstract Background Peak atrial longitudinal strain (PALS) has previously been shown to predict cardiovascular morbidity and mortality in the general population. However, the impact of cardiovascular risk factors on PALS over a decade in participants from the general population is unknown. Purpose The aim of this study was to investigate the impact of cardiovascular risk factors (age, sex, mean arterial pressure (MAP), body mass index (BMI), smoking, total plasma cholesterol, HbA1c, physical activity level, socioeconomic and psychosocial status) on change in PALS over a 10-year period in participants from the general population. Methods The present study included a total of 208 (mean age 61±14 years, 60% female) participants from the general population, who underwent a health examination including two-dimensional speckle tracking echocardiography of the left atrium at baseline examination and follow-up examination. The median time between the examinations was 10 years (interquartile range, 10.2–10.7 years). PALS was calculated as the average from the three apical views. Crude and multivariable linear regression analyses were performed to determine the impact of cardiovascular risk factors on the change in PALS. The multivariable regression model was adjusted for age, sex, MAP, BMI, smoking, total plasma cholesterol, HbA1c, heart rate, eGFR, proBNP and previous ischemic heart disease. All analyses were adjusted for baseline value of PALS (baseline value). Restricted cubic spline curves were constructed to illustrate the relationship between the PALS and continuous cardiovascular risk factors. Results During 10-year follow-up, the average decrease in PALS was 4±16%. In the crude regression model increasing age (standardized = −0.27, p<0.001), MAP (standardized = −0.19, p<0.001), BMI (standardized = −0.19, p<0.001), smoking (standardized = −0.12, p=0.013), higher cholesterol levels (standardized = −0.16, p=0.001), and higher levels of HbA1c (standardized = −0.14, p=0.004) were associated with an accelerated decrease in PALS. Relationship between the PALS and significant continuous cardiovascular risk factors are displayed in restricted cubic spline curves (Figure 1). In the multivariable regression model, age (standardized = −0.19, p=0.001), BMI (standardized = −0.18, p=0.001) and smoking (standardized = −0.15, p=0.003) remained independent predictors of an accelerated decrease in PALS. Conclusion In the general population, increasing age, BMI and smoking were independently associated with an accelerated decrease in PALS over a decade. Funding Acknowledgement Type of funding sources: None.