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Effect of Obesity on Left Atrial Strain in Persons Aged 35-55 Years (The Asklepios Study).

ABSTRACT: Obesity increases the risk of heart failure and atrial fibrillation. Left atrial (LA) dysfunction is increasingly recognized as a mediator of cardiovascular disease. Early effects of obesity on LA function have not been examined in large population samples. We quantified LA strain and strain rate (SR) through speckle tracking echocardiography in 1,531 middle-aged community-based participants enrolled in the Asklepios study. We compared LA function between individuals with body mass index (BMI) < 25 kg/m2 (n?=?779), 25 to 29.9 kg/m2 (n?=?618) and ? 30 kg/m2 (n?=?134). Significant differences in reservoir longitudinal LA strain (BMI < 25 kg/m2?=?35.3%, BMI 25-29.9 kg/m2?=?33.1%, and BMI ? 30 kg/m2?=?30.9%; p < 0.00001) strain rate ([SR] BMI < 25 kg/m2?=?151; BMI 25 to 29.9 kg/m2?=?141; and BMI ? 30 kg/m2?=?135 %/s; p <0.00001) and expansion index (BMI < 25 kg/m2?=?1.6, BMI 25 to 29.9 kg/m2?=?1.4, and BMI ? 30 kg/m2?=?1.4; p <0.00001) were seen, indicating reduced reservoir function with increasing BMI. Obesity was also associated with impaired LA conduit function, including conduit longitudinal LA strain (BMI < 25 kg/m2?=?21.6%, BMI 25 to 29.9 kg/m2?=?18.9%, and BMI ? 30 kg/m2?=?16.7%; p <0.00001), SR (BMI < 25 kg/m2?=?-189, BMI 25 to 29.9 kg/m2?=?166, and BMI ? 30 kg/m2?=?150 %/s; p <0.0001) and passive LA emptying fraction (BMI < 25 kg/m2?=?40.5, BMI 25 to 29.9 kg/m2?=?36.5, and BMI ? 30 kg/m2?=?36%, p <0.00001). These differences persisted after adjustment for age, gender and other potential confounders. In contrast to reservoir and conduit function, obesity was associated with increased booster pump function (active LA emptying fraction: BMI < 25 kg/m2?=?19.4%, BMI 25 to 29.9 kg/m2?=?20.5%, and BMI ? 30 kg/m2?=?21.5%; p <0.00001). In middle-aged adults, obesity is associated with impaired reservoir and conduit LA function and higher booster function, which may be compensatory. Loss of booster LA function, either because of more advanced LA dysfunction or atrial fibrillation, may play an important role in precipitating heart failure in obese individuals.

SUBMITTER: Chirinos JA

PROVIDER: S-EPMC6369023 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Project description:BackgroundModerate intensity exercise is associated with a decreased incidence of atrial fibrillation. However, extensive training in competitive athletes is associated with an increased atrial fibrillation risk. We evaluated the effects of 24 months of high intensity exercise training on left atrial (LA) mechanical and electric remodeling in sedentary, healthy middle-aged adults.MethodsSixty-one participants (53±5 years) were randomized to 10 months of exercise training followed by 14 months of maintenance exercise or stretching/balance control. Fourteen Masters athletes were added for comparison. Left ventricular (LV) and LA volumes underwent 3D echocardiographic assessment, and signal-averaged electrocardiographs for filtered P-wave duration and atrial late potentials were completed at 0, 10, and 24 months. Extended ambulatory monitoring was performed at 0 and 24 months. Within and between group differences from baseline were compared using mixed-effects model repeated-measures analysis.ResultsFifty-three participants completed the study (25 control, 28 exercise) with 88±11% adherence to assigned exercise sessions. In the exercise group, both LA and LV end diastolic volumes increased proportionately (19% and 17%, respectively) after 10 months of training (peak training load). However, only LA volumes continued to increase with an additional 14 months of exercise training (LA volumes 55%; LV end diastolic volumes 15% at 24 months versus baseline; P<0.0001 for all). The LA:LV end diastolic volumes ratio did not change from baseline to 10 months, but increased 31% from baseline in the Ex group ( P<0.0001) at 24 months, without a change in controls. There were no between group differences in the LA ejection fraction, filtered P-wave duration, atrial late potentials, and premature atrial contraction burden at 24 months and no atrial fibrillation was detected. Compared with Masters athletes, the exercise group demonstrated lower absolute LA and LV volumes, but had a similar LA:LV ratio after 24 months of training.ConclusionsTwenty-four months of high intensity exercise training resulted in LA greater than LV mechanical remodeling with no observed electric remodeling. Together, these data suggest different thresholds for electrophysiological and mechanical changes may exist in response to exercise training, and provide evidence supporting a potential mechanism by which high intensity exercise training leads to atrial fibrillation.Clinical trial registrationURL: https://www.clinicaltrials.gov . Unique identifier: NCT02039154.

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Effect of Obesity on Left Atrial Strain in Persons Aged 35-55 Years (The Asklepios Study).

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