Age, Sex, and Blood Pressure-Related Influences on Reference Values of Left Atrial Deformation and Mechanics From a Large-Scale Asian Population

• Published in: Circulation. Cardiovascular imaging Vol. 10; no. 10
• Main Authors: Liao, Jo-Nan, Chao, Tze-Fan, Kuo, Jen-Yuan, Sung, Kuo-Tzu, Tsai, Jui-Peng, Lo, Chi-In, Lai, Yau-Huei, Su, Cheng-Huang, Hung, Chung-Lieh, Yeh, Hung-I, Chen, Shih-Ann
• Format: Journal Article
• Language: English
• Published: United States 01.10.2017
• Subjects: Adult; Age Distribution; Aged; Asian Continental Ancestry Group; Atrial Function, Left; Biomechanical Phenomena; Blood Pressure; Cross-Sectional Studies; Echocardiography, Doppler, Pulsed; Female; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Diseases - diagnostic imaging; Heart Diseases - ethnology; Heart Diseases - physiopathology; Humans; Hypertension - diagnosis; Hypertension - ethnology; Hypertension - physiopathology; Male; Middle Aged; Myocardial Contraction; Predictive Value of Tests; Reference Values; Retrospective Studies; Risk Factors; Sex Distribution; Taiwan; reference values; atrial function, left
• ISSN: 1941-9651; 1942-0080
• DOI: 10.1161/circimaging.116.006077

Left atrial (LA) function is tightly linked to several cardiovascular diseases and confers key prognostic information. Speckle tracking-based deformation as a feasible and sensitive LA mechanical assessment has proven its clinical significance beyond volume measures; however, the reference values remain largely unknown. We studied 4042 participants undergoing annual cardiovascular survey. Among them, 2812 healthy participants (65% men; mean age, 47.4±9.9 years) were eligible for speckle tracking analysis. Peak atrial longitudinal systolic strain and strain rate (SR) at systolic (SRs), early diastolic (SRe), and late diastolic atrial contraction phases (SRa) were analyzed by dedicated software (EchoPAC, GE) and compared in terms of age, sex, and blood pressure. Overall, women demonstrated higher peak atrial longitudinal systolic strain (39.34±7.99% versus 37.95±7.96%; P<0.001) and showed age-dependent more pronounced peak atrial longitudinal systolic strain functional decay than those of men (P value for interaction, <0.05), with men showing higher SRs and SRa, although lower SRe (all P<0.001). Both increasing age and higher blood pressure were independently associated with deteriorated peak atrial longitudinal systolic strain, SRs, and SRe, although augmented LA SRa, even after accounting for baseline clinical covariates in multivariable models that incorporated LA volume, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or left ventricular E/e' (all P<0.001). Our findings suggest LA mechanical functional decays in association with increasing age and higher blood pressure, which seem to be compensated for by augmentation of atrial pump function. We have also provided age- and sex-stratified reference values for strain and SR based on a large-scale Asian population.