Clinical and Biochemical Predictors of Longitudinal Changes in Left Atrial Structure and Function: A General Population Study.

PurposeThere is a need for better understanding the factors that modulate left atrial (LA) dysfunction. Therefore, we determined associations of clinical and biochemical biomarkers with serial changes in echocardiographic indexes of LA function in the general population.MethodsWe measured LA maximal and minimal volume indexes (LAVImax and LAVImin) by echocardiography and LA reservoir strain (LARS) by two-dimensional speckle-tracking in 627 participants (mean age 50.8 years, 51.2% women) at baseline and after 4.8 years.ResultsDuring follow-up, LARS decreased significantly in men (-.90%, P = .033) but not in women (-.23%, P = .60). In stepwise regression analysis, stronger decrease in LARS over time was associated with male sex, a higher age, body mass index (BMI), mean arterial pressure (MAP) and serum insulin at baseline and with a greater increase in BMI and MAP over time (P <= .018). Similarly, an increased risk of developing or retaining abnormal LARS was observed in older participants, in subjects with a higher baseline BMI, MAP, heart rate (HR), troponin T and Delta MAP, and in those who used beta-blockers at baseline. Both LAVImax and LAVImin increased significantly over time (P <= .0007). This increase was associated with a higher baseline age, pulse pressure and a lower HR at baseline and a greater increase in pulse pressure over time (P <= .029). Higher serum insulin and D-dimer were independently associated with a stronger increase in LAVImin (P <= .0034).ConclusionSubclinical worsening in LA dysfunction was associated with older age, hypertension, obesity, insulin resistance and troponin T levels. Cardiovascular risk management strategies may delay LA deterioration. In a general population cohort of 627 individuals, subclinical worsening of LA function over time was associated with higher age, hypertension, obesity, insulin resistance and higher troponin T levels at baseline. image