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The effect of body weight on left atrial function determined by longitudinal strain analysis in young adults

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Abstract

Purpose

Obesity is a risk factor for various cardiovascular disorders. Left atrial (LA) function is vital for predicting adverse outcomes in many diseases. LA strain was recently proposed as a noninvasive and valuable parameter for LA functional evaluation. We investigated the effect of body mass index (BMI) values on left atrial functions determined by longitudinal strain analysis in young adults without concomitant disease.

Methods

We prospectively included 134 subjects in our study. Participants were categorized into three subgroups, obese, overweight, and control, according to their BMI. Conventional echocardiographic measurements and strain analysis were performed on all patients.

Results

There were 41 patients (30.5%) in the obesity group, 46 patients (34.3%) in the overweight group, and 47 patients (35.0%) in the control group. Obese patients had significantly larger LA volume (46.9 ± 12.1 ml; p < 0.001) compared to overweight and control subjects; however, LA volume index (21.4 ± 6.1 ml/m2 vs. 22.4 ± 6.1 ml/m2 vs. 22.4 ± 5.0 ml/m2; p = 0.652) were similar between groups. In the LA strain analysis, obese patients were found to have lower left atrial reservoir longitudinal strain (LASr) compared to both the overweight and control group (44.2 ± 5.8% vs. 39.1 ± 3.7% vs. 36.5 ± 4.9%; p < 0.001); moreover obese patients had significantly worse left atrial contraction phase longitudinal strain (LASct) (-15.1 ± 3.1% vs. -13.1 ± 2.5%; p = 0.007) and left atrial conduit phase longitudinal strain (LAScd) (-29.0 ± 7.1% vs. -23.3 ± 5.4%; p < 0.001) values compared to the control group. However, LASct and LAScd values did not differ between overweight and obese patients.

Conclusion

LA function determined by LA strain analysis was impaired in obese and overweight individuals compared to the control group, even in the early stages of life. The prognostic significance of this finding should be investigated in prospective studies.

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Data Availability

Data available on request due to privacy/ethical restrictions.

Code Availability

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References

  1. Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an Independent risk factor for Cardiovascular Disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67(5):968–977 Epub 1983/05/01. https://doi.org/10.1161/01.cir.67.5.968

    Article  CAS  PubMed  Google Scholar 

  2. Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ et al (2011) Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis risk in communities (ARIC) study. Circulation 123(14):1501–1508 PubMed PMID: 21444879; PubMed Central PMCID: PMCPMC3181498

    Article  PubMed  PubMed Central  Google Scholar 

  3. Alpert MA, Omran J, Bostick BP (2016) Effects of obesity on Cardiovascular Hemodynamics, Cardiac morphology, and ventricular function. Curr Obes Rep 5(4):424–434 Epub 2016/10/17. https://doi.org/10.1007/s13679-016-0235-6

    Article  PubMed  Google Scholar 

  4. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popovic ZB, Thomas JD et al (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23(2):172–180 PubMed PMID: 20152699

    Article  PubMed  Google Scholar 

  5. Yuda S, Muranaka A, Miura T (2016) Clinical implications of left atrial function assessed by speckle tracking echocardiography. J Echocardiogr 14(3):104–112 Epub 2016/03/10. https://doi.org/10.1007/s12574-016-0283-7

    Article  PubMed  Google Scholar 

  6. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S et al (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3(3):231–239 Epub 2010/02/06. https://doi.org/10.1161/CIRCIMAGING.109.865683

    Article  PubMed  Google Scholar 

  7. Malagoli A, Rossi L, Bursi F, Zanni A, Sticozzi C, Piepoli MF et al (2019) Left atrial function predicts Cardiovascular events in patients with chronic Heart Failure with reduced ejection fraction. J Am Soc Echocardiogr 32(2):248–256 Epub 2018/10/15. https://doi.org/10.1016/j.echo.2018.08.012

    Article  PubMed  Google Scholar 

  8. Vieira MJ, Teixeira R, Goncalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27(5):463–478 Epub 2014/03/25. https://doi.org/10.1016/j.echo.2014.01.021

    Article  PubMed  Google Scholar 

  9. Bacha F, Gidding SS (2016) Cardiac abnormalities in youth with obesity and type 2 Diabetes. Curr Diab Rep 16(7):62 Epub 2016/05/12. https://doi.org/10.1007/s11892-016-0750-6

    Article  CAS  PubMed  Google Scholar 

  10. Steele JM, Urbina EM, Mazur WM, Khoury PR, Nagueh SF, Tretter JT, Alsaied T (2020) Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults. Cardiovasc Diabetol 19(1):163. https://doi.org/10.1186/s12933-020-01139-9PMID: 33004030; PMCID: PMC7531140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Alonso Gómez AM, Sierra LT, Mora NM, Toledo E, Alonso A, Uriarte MG, Sanchez CS, Portillo MP, Rodriguez LL, Arellano EE, Schröder H, Salas-Salvadó J (2022) Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity. Int J Cardiol 348:169–174 Epub 2021 Dec 8. PMID: 34890763; PMCID: PMC8980725

    Article  PubMed  Google Scholar 

  12. Chirinos JA, Sardana M, Satija V, Gillebert TC, De Buyzere ML, Chahwala J, De Bacquer D, Segers P, Rietzschel ER (2019) Asklepios investigators. Effect of obesity on left atrial strain in persons aged 35–55 years (the Asklepios Study). Am J Cardiol 123(5):854–861 Epub 2018 Dec 4. PMID: 30563614; PMCID: PMC6369023

    Article  PubMed  Google Scholar 

  13. Tadic M, Cuspidi C, Ilic I, Suzic-Lazić J, Zivanovic V, Jozika L, Celic V (2016) The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population. Int J Cardiovasc Imaging 32(4):603–612. https://doi.org/10.1007/s10554-015-0822-8Epub 2015 Dec 12. PMID: 26662267

    Article  PubMed  Google Scholar 

  14. Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2014) Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with Hypertension: a two-dimensional speckle-tracking echocardiographic study. J Am Soc Hypertens 8(1):54–63 Epub 2013 Oct 13. PMID: 24131668

    Article  PubMed  Google Scholar 

  15. Ardern CI, Katzmarzyk PT, Janssen I, Church TS, Blair SN (2005) Revised Adult Treatment Panel III guidelines and Cardiovascular Disease mortality in men attending a preventive medical clinic. Circulation 112(10):1478–1485 Epub 2005/09/01. https://doi.org/10.1161/CIRCULATIONAHA.105.548198

    Article  PubMed  Google Scholar 

  16. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults (2016) An update from the American Society of Echocardiography and the European Association of, Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(4):412 Epub 2016/03/18. https://doi.org/10.1093/ehjci/jew041

    Article  Google Scholar 

  17. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19(6):591–600 Epub 2018/03/30. https://doi.org/10.1093/ehjci/jey042

    Article  PubMed  Google Scholar 

  18. Aiad NN, Hearon C Jr., Hieda M, Dias K, Levine BD, Sarma S (2019) Mechanisms of left atrial enlargement in obesity. Am J Cardiol 124(3):442–447 Epub 2019/05/28. https://doi.org/10.1016/j.amjcard.2019.04.043

    Article  PubMed  Google Scholar 

  19. Davis EF, Crousillat DR, He W, Andrews CT, Hung JW, Danik JS (2022) Indexing left Atrial volumes: alternative indexing methods better predict outcomes in overweight and obese populations. JACC Cardiovasc Imaging 15(6):989–997. https://doi.org/10.1016/j.jcmg.2022.02.006Epub 2022 Apr 13. PMID: 35680231

    Article  PubMed  Google Scholar 

  20. Nassri Camara EJ, do Prado Valladares FR, Key NK, Santana PF, Kawaoka JR, Campos TH, Santana MRO, Cunha AC, Sampaio DS, Santana GP, Brito LGS, Dourado NOC, Nascimento SJ, Lira APAL, do Nascimento NN, Dos Santos RPF, Rocha SRF, Machado TG (2023) Indexing of Left Atrial volume by body surface area and height in a Brazilian Population without previous Heart Disease and with a normal heart on Echocardiography. Behavior in obese and overweight patients. Cardiol Cardiovasc Med 7(1):25–31. https://doi.org/10.26502/fccm.92920304Epub 2023 Jan 29. PMID: 36937650; PMCID: PMC10019596

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S et al (2012) Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 110(2):264–269 Epub 2012/04/14. https://doi.org/10.1016/j.amjcard.2012.03.022

    Article  PubMed  Google Scholar 

  22. Gan GCH, Ferkh A, Boyd A, Thomas L (2018) Left atrial function: evaluation by strain analysis. Cardiovasc Diagn Ther 8(1):29–46 Epub 2018/03/16. https://doi.org/10.21037/cdt.2017.06.08

    Article  PubMed  PubMed Central  Google Scholar 

  23. Casaclang-Verzosa G, Gersh BJ, Tsang TS (2008) Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol 51(1):1–11 Epub 2008/01/05. https://doi.org/10.1016/j.jacc.2007.09.026

    Article  PubMed  Google Scholar 

  24. Yagmur J, Cansel M, Kurtoglu E, Hidayet S, Acikgoz N, Ermis N et al (2017) Assessment of left atrial volume and function by real time three-dimensional echocardiography in obese patients. Echocardiography 34(2):210–216 Epub 2016/12/10. https://doi.org/10.1111/echo.13417

    Article  PubMed  Google Scholar 

  25. Aga YS, Kroon D, Snelder SM, Biter LU, de Groot-de Laat LE, Zijlstra F et al (2022) Decreased left atrial function in obesity patients without known Cardiovascular Disease. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-022-02744-3PubMed PMID: 36306046 Epub 2022/10/29

    Article  PubMed  PubMed Central  Google Scholar 

  26. Abed HS, Samuel CS, Lau DH, Kelly DJ, Royce SG, Alasady M et al (2013) Obesity results in Progressive atrial structural and electrical remodeling: implications for atrial fibrillation. Heart Rhythm 10(1):90–100 Epub 2012/10/16. https://doi.org/10.1016/j.hrthm.2012.08.043

    Article  PubMed  Google Scholar 

  27. Cameli M, Sparla S, Losito M, Righini FM, Menci D, Lisi M et al (2016) Correlation of left atrial strain and doppler measurements with Invasive Measurement of Left Ventricular End-Diastolic pressure in patients stratified for different values of Ejection Fraction. Echocardiography 33(3):398–405 Epub 2015/10/24. https://doi.org/10.1111/echo.13094

    Article  PubMed  Google Scholar 

  28. Kurt M, Tanboga IH, Aksakal E, Kaya A, Isik T, Ekinci M et al (2012) Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters. Eur Heart J Cardiovasc Imaging 13(6):524–530 Epub 2011/12/15. https://doi.org/10.1093/ejechocard/jer283

    Article  PubMed  Google Scholar 

  29. Blomstrand P, Sjöblom P, Nilsson M, Wijkman M, Engvall M, Länne T, Nyström FH, Östgren CJ, Engvall J (2018) Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol 17(1):113

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nagueh S, Khan S et al (2023) Left Atrial Strain for Assessment of Left Ventricular Diastolic Function. J Am Coll Cardiol Img. null 0 (0)

  31. Chahine Y, Askari-Atapour B, Kwan KT, Anderson CA, Macheret F, Afroze T, Bifulco SF, Cham MD, Ordovas K, Boyle PM, Akoum N (2022) Epicardial adipose tissue is associated with left atrial volume and fibrosis in patients with atrial fibrillation. Front Cardiovasc Med 9:1045730

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pouwels S, Topal B, Knook MT, Celik A, Sundbom M, Ribeiro R et al (2019) Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management. Expert Rev Cardiovasc Ther 17(3):209–223 PubMed PMID: 30757925

    Article  CAS  PubMed  Google Scholar 

  33. Vyas V, Lambiase P (2019) Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic opportunities. Arrhythm Electrophysiol Rev 8(1):28–36 Epub 2019/03/29. https://doi.org/10.15420/aer.2018.76.2

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sade LE, Keskin S, Can U, Colak A, Yuce D, Ciftci O et al (2022) Left atrial mechanics for secondary prevention from embolic Stroke of undetermined source. Eur Heart J Cardiovasc Imaging 23(3):381–391 Epub 2020/11/19. https://doi.org/10.1093/ehjci/jeaa311

    Article  PubMed  Google Scholar 

  35. Her AY, Choi EY, Shim CY, Song BW, Lee S, Ha JW et al (2012) Prediction of left atrial fibrosis with speckle tracking echocardiography in mitral valve Disease: a comparative study with histopathology. Korean Circ J 42(5):311–318 PubMed PMID: 22701133; PubMed Central PMCID: PMCPMC3369962

    Article  PubMed  PubMed Central  Google Scholar 

  36. Laish-Farkash A, Perelshtein Brezinov O, Valdman A, Tam D, Rahkovich M, Kogan Y et al (2021) Evaluation of left atrial remodeling by 2D-speckle-tracking echocardiography versus by high-density voltage mapping in patients with atrial fibrillation. J Cardiovasc Electrophysiol 32(2):305–315 Epub 2020/12/18. https://doi.org/10.1111/jce.14837

    Article  PubMed  Google Scholar 

  37. Hohendanner F, Romero I, Blaschke F, Heinzel FR, Pieske B, Boldt LH et al (2018) Extent and magnitude of low-voltage areas assessed by ultra-high-density electroanatomical mapping correlate with left atrial function. Int J Cardiol 272 Epub 2018/07/19. https://doi.org/10.1016/j.ijcard.2018.07.048. :108–12

  38. Alhakak AS, Biering-Sorensen SR, Mogelvang R, Modin D, Jensen GB, Schnohr P et al (2022) Usefulness of left atrial strain for predicting incident atrial fibrillation and ischaemic Stroke in the general population. Eur Heart J Cardiovasc Imaging 23(3):363–371 Epub 2020/11/12. https://doi.org/10.1093/ehjci/jeaa287

    Article  PubMed  Google Scholar 

  39. Unlu S, Mirea O, Bezy S, Duchenne J, Pagourelias ED, Bogaert J et al (2021) Inter-vendor variability in strain measurements depends on software rather than image characteristics. Int J Cardiovasc Imaging 37(5):1689–1697 Epub 2021/01/18. https://doi.org/10.1007/s10554-020-02155-2

    Article  PubMed  Google Scholar 

  40. Peters DC, Lamy J, Sinusas AJ, Baldassarre LA (2021) Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 23(1):14–30 Epub 2021/11/01. https://doi.org/10.1093/ehjci/jeab221

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey

    Burak Sezenöz, Serkan Ünlü, Yakup Yalçın, Betül Ayça Yamak, Elif Yazgan, Sedat Türkoğlu & Gülten Taçoy

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  1. Burak Sezenöz
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  2. Serkan Ünlü
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Contributions

All authors have read and approved the manuscript. We have nothing to disclose. The listed authors contributed to the manuscript, in the following manner: - conception and design or analysis and interpretation of data, or both (BS, SÜ, YY, BAY, EY) - manuscript drafting or critical revision for important intellectual content (BS, SÜ, ST, GT); - final approval of the manuscript submitted (SÜ, ST, GT).

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Correspondence to Serkan Ünlü.

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The study was approved by the Gazi University Faculty of Medicine Ethics Committee on 22/11/2019 with document number 2019/233.

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Sezenöz, B., Ünlü, S., Yalçın, Y. et al. The effect of body weight on left atrial function determined by longitudinal strain analysis in young adults. Int J Cardiovasc Imaging 40, 407–414 (2024). https://doi.org/10.1007/s10554-023-03008-4

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