Ratio of left atrial to left ventricular size: An anatomical marker of the diastolic left ventricular pressure-volume relationship

Daniel M. Spevack, Liran Blum, Divya Malhotra, Reza Nazari, Robert J Ostfeld, Sanjay Doddamani, Ricardo Bello, Hillel W. Cohen, Edmund H. Sonnenblick

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Classification of diastolic heart function is best defined by the degree of leftward and upward shift of the diastolic pressure-volume relationship (DPVR). Direct measurement of DPVR, however, requires invasive techniques. Increased left atrial (LA) size is a marker of left ventricular (LV) diastolic hypertension, and so, the LA/LV diameter ratio has the potential to mark the degree of upward and leftward shift in the LV-DPVR. We thus investigated the association of this novel marker with exposures known to induce diastolic dysfunction and with clinical evidence of diastolic dysfunction. Methods and Results: Reports from 7,803 patients undergoing maximal exercise stress echocardiography were reviewed. Increased LA/LV diameter ratio predicted diminished exercise capacity (P < 0.001) in a multivariate regression analysis. Increased LA and decreased LV diameters were each independently associated with exercise capacity (P < 0.001, both). Increased LA/LV diameter ratio was associated with hypertension (P = 0.001), diabetes (P = 0.03) and with increased severity of LV hypertrophy (P< 0.001). Those with LA/LV diameter ratio > 1.0 were more likely to use loop diuretics, odds ratio = 2.5 [95% CI, 1.4, 4.5], compared to those with lower ratio values. Conclusions: Increased LA/LV diameter ratio was observed in subjects with hypertension, diabetes and LV hypertrophy. Increased ratio predicted worse exercise capacity and was associated with more frequent loop diuretic use. These data are consistent with the hypothesis that this ratio is a noninvasive marker of the LV-DPVR.

Original languageEnglish (US)
Pages (from-to)366-373
Number of pages8
JournalEchocardiography
Volume25
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Ventricular Pressure
Blood Pressure
Sodium Potassium Chloride Symporter Inhibitors
Exercise
Hypertension
Stress Echocardiography
Left Ventricular Hypertrophy
Odds Ratio

Keywords

  • Atrium
  • Diastole
  • Exercise
  • Hypertrophy
  • Ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Ratio of left atrial to left ventricular size : An anatomical marker of the diastolic left ventricular pressure-volume relationship. / Spevack, Daniel M.; Blum, Liran; Malhotra, Divya; Nazari, Reza; Ostfeld, Robert J; Doddamani, Sanjay; Bello, Ricardo; Cohen, Hillel W.; Sonnenblick, Edmund H.

In: Echocardiography, Vol. 25, No. 4, 04.2008, p. 366-373.

Research output: Contribution to journalArticle

Spevack, DM, Blum, L, Malhotra, D, Nazari, R, Ostfeld, RJ, Doddamani, S, Bello, R, Cohen, HW & Sonnenblick, EH 2008, 'Ratio of left atrial to left ventricular size: An anatomical marker of the diastolic left ventricular pressure-volume relationship', Echocardiography, vol. 25, no. 4, pp. 366-373. https://doi.org/10.1111/j.1540-8175.2007.00619.x
Spevack, Daniel M. ; Blum, Liran ; Malhotra, Divya ; Nazari, Reza ; Ostfeld, Robert J ; Doddamani, Sanjay ; Bello, Ricardo ; Cohen, Hillel W. ; Sonnenblick, Edmund H. / Ratio of left atrial to left ventricular size : An anatomical marker of the diastolic left ventricular pressure-volume relationship. In: Echocardiography. 2008 ; Vol. 25, No. 4. pp. 366-373.
@article{1dd7b53cc8a44d66ad85e419061044b4,
title = "Ratio of left atrial to left ventricular size: An anatomical marker of the diastolic left ventricular pressure-volume relationship",
abstract = "Background: Classification of diastolic heart function is best defined by the degree of leftward and upward shift of the diastolic pressure-volume relationship (DPVR). Direct measurement of DPVR, however, requires invasive techniques. Increased left atrial (LA) size is a marker of left ventricular (LV) diastolic hypertension, and so, the LA/LV diameter ratio has the potential to mark the degree of upward and leftward shift in the LV-DPVR. We thus investigated the association of this novel marker with exposures known to induce diastolic dysfunction and with clinical evidence of diastolic dysfunction. Methods and Results: Reports from 7,803 patients undergoing maximal exercise stress echocardiography were reviewed. Increased LA/LV diameter ratio predicted diminished exercise capacity (P < 0.001) in a multivariate regression analysis. Increased LA and decreased LV diameters were each independently associated with exercise capacity (P < 0.001, both). Increased LA/LV diameter ratio was associated with hypertension (P = 0.001), diabetes (P = 0.03) and with increased severity of LV hypertrophy (P< 0.001). Those with LA/LV diameter ratio > 1.0 were more likely to use loop diuretics, odds ratio = 2.5 [95{\%} CI, 1.4, 4.5], compared to those with lower ratio values. Conclusions: Increased LA/LV diameter ratio was observed in subjects with hypertension, diabetes and LV hypertrophy. Increased ratio predicted worse exercise capacity and was associated with more frequent loop diuretic use. These data are consistent with the hypothesis that this ratio is a noninvasive marker of the LV-DPVR.",
keywords = "Atrium, Diastole, Exercise, Hypertrophy, Ventricle",
author = "Spevack, {Daniel M.} and Liran Blum and Divya Malhotra and Reza Nazari and Ostfeld, {Robert J} and Sanjay Doddamani and Ricardo Bello and Cohen, {Hillel W.} and Sonnenblick, {Edmund H.}",
year = "2008",
month = "4",
doi = "10.1111/j.1540-8175.2007.00619.x",
language = "English (US)",
volume = "25",
pages = "366--373",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Ratio of left atrial to left ventricular size

T2 - An anatomical marker of the diastolic left ventricular pressure-volume relationship

AU - Spevack, Daniel M.

AU - Blum, Liran

AU - Malhotra, Divya

AU - Nazari, Reza

AU - Ostfeld, Robert J

AU - Doddamani, Sanjay

AU - Bello, Ricardo

AU - Cohen, Hillel W.

AU - Sonnenblick, Edmund H.

PY - 2008/4

Y1 - 2008/4

N2 - Background: Classification of diastolic heart function is best defined by the degree of leftward and upward shift of the diastolic pressure-volume relationship (DPVR). Direct measurement of DPVR, however, requires invasive techniques. Increased left atrial (LA) size is a marker of left ventricular (LV) diastolic hypertension, and so, the LA/LV diameter ratio has the potential to mark the degree of upward and leftward shift in the LV-DPVR. We thus investigated the association of this novel marker with exposures known to induce diastolic dysfunction and with clinical evidence of diastolic dysfunction. Methods and Results: Reports from 7,803 patients undergoing maximal exercise stress echocardiography were reviewed. Increased LA/LV diameter ratio predicted diminished exercise capacity (P < 0.001) in a multivariate regression analysis. Increased LA and decreased LV diameters were each independently associated with exercise capacity (P < 0.001, both). Increased LA/LV diameter ratio was associated with hypertension (P = 0.001), diabetes (P = 0.03) and with increased severity of LV hypertrophy (P< 0.001). Those with LA/LV diameter ratio > 1.0 were more likely to use loop diuretics, odds ratio = 2.5 [95% CI, 1.4, 4.5], compared to those with lower ratio values. Conclusions: Increased LA/LV diameter ratio was observed in subjects with hypertension, diabetes and LV hypertrophy. Increased ratio predicted worse exercise capacity and was associated with more frequent loop diuretic use. These data are consistent with the hypothesis that this ratio is a noninvasive marker of the LV-DPVR.

AB - Background: Classification of diastolic heart function is best defined by the degree of leftward and upward shift of the diastolic pressure-volume relationship (DPVR). Direct measurement of DPVR, however, requires invasive techniques. Increased left atrial (LA) size is a marker of left ventricular (LV) diastolic hypertension, and so, the LA/LV diameter ratio has the potential to mark the degree of upward and leftward shift in the LV-DPVR. We thus investigated the association of this novel marker with exposures known to induce diastolic dysfunction and with clinical evidence of diastolic dysfunction. Methods and Results: Reports from 7,803 patients undergoing maximal exercise stress echocardiography were reviewed. Increased LA/LV diameter ratio predicted diminished exercise capacity (P < 0.001) in a multivariate regression analysis. Increased LA and decreased LV diameters were each independently associated with exercise capacity (P < 0.001, both). Increased LA/LV diameter ratio was associated with hypertension (P = 0.001), diabetes (P = 0.03) and with increased severity of LV hypertrophy (P< 0.001). Those with LA/LV diameter ratio > 1.0 were more likely to use loop diuretics, odds ratio = 2.5 [95% CI, 1.4, 4.5], compared to those with lower ratio values. Conclusions: Increased LA/LV diameter ratio was observed in subjects with hypertension, diabetes and LV hypertrophy. Increased ratio predicted worse exercise capacity and was associated with more frequent loop diuretic use. These data are consistent with the hypothesis that this ratio is a noninvasive marker of the LV-DPVR.

KW - Atrium

KW - Diastole

KW - Exercise

KW - Hypertrophy

KW - Ventricle

UR - http://www.scopus.com/inward/record.url?scp=41149105939&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41149105939&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8175.2007.00619.x

DO - 10.1111/j.1540-8175.2007.00619.x

M3 - Article

C2 - 18366354

AN - SCOPUS:41149105939

VL - 25

SP - 366

EP - 373

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 4

ER -