Left atrial volume as an independent predictor of exercise capacity in patients with isolated diastolic dysfunction presented with exertional dyspnea.

backgroundLeft atrial volume (LAV) and exercise capacity are important prognostic determinants of cardiovascular risk. Exercise intolerance and increased LAV are expected in patients with diastolic dysfunction. While dyspnea is the symptom reported by the patient and considered subjective, exercise capacity obtained by exercise testing provides an objective measure of cardiovascular fitness. The objective of this study is to determine the relationship between LAV index and exercise capacity in patients with isolated diastolic dysfunction who presented with exertional dyspnea.

methodsWe studied consecutive patients with dyspnea who underwent treadmill exercise testing and transthoracic echocardiography on the same day. LAV was assessed using the biplane area-length method. Symptom-limited exercise testing was performed immediately after echocardiography. Patients with coronary artery disease, valvular or congenital heart disease, left ventricular systolic dysfunction, pulmonary hypertension or positive exercise test were excluded.

resultsThe study consisted of 111 patients (58.1 ± 9.2 years of age, 54.1% male, 64% hypertension, 57.7% dyslipidemia and 20.7% diabetes). The exercise duration and capacity were 6.8 ± 2.1 minutes and 7.7 ± 1.9 METs, respectively. Left ventricular ejection fraction and LAV index was 71.0 ± 5.8% and 31.4 ± 10.5 ml/m2, respectively. In multivariate analysis, age [odds ratios (OR) 0.94; 95% confidence interval (CI) 0.89-0.99], body mass index (OR 0.82, 95% CI 0.72-0.93), and LAV index (OR 0.92, 95% CI 0.87-0.97) were associated with good exercise capacity.

conclusionIn patients with isolated diastolic dysfunction and exertional dyspnea, an increased LAV index, a marker of chronic diastolic dysfunction, is associated with poor exercise capacity.