LEFT ATRIAL TO LEFT VENTRICULAR END DIASTOLIC DIAMETER RATIO IN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION

Authors

  • Inam ul Haq Associate Professor Physiology, Rawalpindi Medical College, Tipu Road, Rawalpindi, Pakistan.
  • Muhammad Saeed Consultant Cardiologist, Holy Family Hospital
  • Muhammad Hamza Students, Rawalpindi Medical College, Rawalpindi, Pakistan
  • Agha Shabbir Ali Students, Rawalpindi Medical College, Rawalpindi, Pakistan
  • Maha Nadir Students, Rawalpindi Medical College, Rawalpindi, Pakistan

DOI:

https://doi.org/10.69656/pjp.v13i1.258

Keywords:

Diastolic dysfunction, atrial, ventricular, echocardiography, atrio-ventricular diameter ratio, cardiac

Abstract

Background: Diastolic dysfunction (DD) is difficult to diagnose and characterize despite many techniques. It is known that left atrial diameter (LAD) increases and left ventricular internal end diastolic diameter (LVIDD) remains the same in moderate to severe diastolic dysfunction (grade II and above) but a ratio between these two (LAD/LVIDD) has never been used to assess diastolic dysfunction. This study aims to analyze the relationship between the ratio, left atrial diameter/ left ventricular internal end diastolic diameter (LAD/LVIDD) and diastolic dysfunction (grade II and above). This study also aims to give a statistical model based upon this relationship that is able to help in diagnosing diastolic dysfunction. Methods: This case control analytical study was carried out at the Department of Cardiology, Holy Family Hospital, Rawalpindi, from Jan 2014 to Jan 2016. On the basis of echocardiographic findings, 226 patients were identified as normal healthy control group whereas 226 patients were identified as having diastolic dysfunction of grade II and above and were categorised as disease group. Doppler diastolic function parameters were used to assess diastolic function in all of these 452 patients. Appropriate statistical methods were then applied on the data by using IBM statistical package for social sciences (SPSS). Results: LAD/LVIDD was correlated to diastolic dysfunction at r=0.858 (p<0.01). A binary logistic regression model using age, sex and LAD/LVIDD gave an accuracy of 96.9% in diagnosing diastolic dysfunction. LAD/LVIDD in the model had an odds ratio of 2.678´1024. A Receiver Operation Characteristic curve between diastolic dysfunction and LAD/LVIDD yielded a specificity of 93.8% and sensitivity of 99.1% at the cut-off value of 0.7268. Conclusion: A new parameter, left atrial diameter (LAD) to left ventricular internal end diastolic diameter (LVIDD) ratio (LAD/LVIDD), is significantly correlated to diastolic dysfunction (grade II and above). It is also a significant predictor for diastolic dysfunction.

Pak J Physiol 2017;13(1):15–8

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References

1. Aziz F, Luqman-arafath T, Enweluzo C, Dutta C, Zaeeem M. Diastolic Heart Failure: A Concise Review. J Clin Med Res 2013;5(5):327–34.
2. Kitzman D, Little W, Brubaker P, Anderson R, Hundley W, Marburger C, et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA 2002;288:2144–50.
3. Caruana L, Petrie MC, Davie AP, McMurray JJV. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from ‘diastolic heart failure’ or from misdiagnosis? A prospective descriptive study. BMJ 2000;321(7255):215–8.
4. Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: An epidemiologic perspective. J Am Coll Cardiol 1995;26:1565–74.
5. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: Diagnosis, prognosis, and measurements of diastolic function. Circulation 2002;105:1387–93.
6. Galderisi M. Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects. Cardiovasc Ultrasound 2005;3(1):9. DOI: 10.1186/1476-7120-3-9
7. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22(2):107–33.
8. Paulus WJ, Tschope C, Sanderson J, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007;28(20):2539–50.
9. Rakowski H, Appleton C, Chan KL, Dumesnil JG, Honos G, Jue J, et al. Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the Investigators of Consensus on Diastolic Dysfunction by Echocardiography. J Am Soc Echocardiogr 1996;9(5):736–60.
10. Giannuzzi P, Imparato A, Temporelli PL, de Vito F, Silva PL, Scapellato F, et al. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol 1994;23(7):1630–7.
11. Masugata H, Senda S, Inukai M, Murao K, Hosomi N, Iwado Y, et al. Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function. J Int Med Res 2011;39(3):772–9.
12. Gerdts E, Oikarinen L, Palmieri V, Otterstad JE, Wachtell K, Boman K, et al. Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy. Hypertension 2002;39(3):739–43.
13. Adamu UG, Kolo PM, Katibi IA, Opadijo GO, Omotosho ABO. Relationship between left ventricular diastolic function and geometric patterns in Nigerians with newly diagnosed systemic hypertension. Cardiovasc J Afr 2009;20(3):173–7.
14. Germing A, Gotzmann M, Schikowski T, Vierkötter A, Ranft U, Mügge A, et al. Diastolic dysfunction without abnormalities in left atrial and left ventricular geometry does not affect quality of life in elderly women. Exp Clin Cardiol 2011;16(2):37–9.
15. Zile MR, LeWinter MM. Left ventricular end-diastolic volume is normal in patients with heart failure and a normal ejection fraction: A renewed consensus in diastolic heart failure. J Am Coll Cardiol 2007;49(9):982–5.
16. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58(6):1072–83.
17. Teo SG, Yang H, Chai P, Yeo TC. Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis. Eur J Echocardiogr 2010;11(1):38–43.
18. El Aoura LM, Meyerfreud D, Magalhaes P, Rodrigues SL, Baldo MP, Brasil Y, et al. Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients. Arq Bras Cardiol 2013;101(1):52–8.
19. Pritchett AM, Mahoney DW, Jacobsen SJ, Rodeheffer RJ, Karon BL, Redfield MM. Diastolic dysfunction and left atrial volume: A population-based study. J Am Coll Cardiol 2005;45(1):87–92.

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Published

31-03-2017

How to Cite

1.
Haq I ul, Saeed M, Hamza M, Ali AS, Nadir M. LEFT ATRIAL TO LEFT VENTRICULAR END DIASTOLIC DIAMETER RATIO IN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION. Pak J Phsyiol [Internet]. 2017 Mar. 31 [cited 2024 Nov. 21];13(1):15-8. Available from: https://pjp.pps.org.pk/index.php/PJP/article/view/258

Issue

Vol. 13 No. 1 (2017): Pakistan Journal of Physiology

Section

Original Article

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Pakistan Journal of Physiology, Pak J Physiol, PJP is FREE for research and academic purposes. It can be freely downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.