ABC | Volume 112, Nº3, March 2019

Original Article Echocardiographic Correlation between Right Ventricular Function and Left Atrial Volume Liz Andréa Villela Baroncini, 1 L ucas José Lira Borges, 2 Ana Cristina Camarozano, 1 Daniela de Castro Carmo, 2 Rubens Zenobio Darwich, 2 Jeronimo Antonio Fortunato Junior 2 Instituto Saber e Aprender, 1 Curitiba, PR - Brazil Hospital da Cruz Vermelha – Cruz Vermelha Brasileira - Filial do Estado do Paraná, 2 Curitiba, PR – Brazil Mailing Address: Liz Andréa Villela Baroncini • Rua Buenos Aires, 764, apt. 601. Postal Code 80250-070, Batel, Curitiba, PR – Brazil E-mail: lizavb@cardiol.br , lizandreabaroncini@hotmail.com Manuscript received February 25, 2018, revised manuscript May 25, 2018, accepted July 23, 2018 DOI: 10.5935/abc.20190042 Abstract Background: Few reports exist on the relationship of the left ventricular diastolic dysfunction (LVDD) with its most important features including enlargement of the left atrium and left ventricular hypertrophy (LVH), and with the right ventricular (RV) function. Objective: To determine the correlation between the left atrial size and the RV function and dimensions in patients with and without LVDD and LVH. Methods: Fifty patients were included, 25 (40% men) of them with LVDD, aged 67.1 ± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9 ± 16.3 years (control group). Patients underwent transthoracic echocardiography with evaluation of the left atrial size and volume (LAV), LVDD, LVH, and RV function and dimensions. P-values < 0.05 were considered statistically significant. Results: LAV > 34 mL/m² and left atrial size > 40 mm were associated with lower absolute values of tricuspid annular plane systolic excursion (TAPSE) and RV lateral S’ (p ≤ 0.001, Pearson’s correlation coefficient -0.4 and -0.38, respectively) in the study group. Patients in the study group showed higher incidence of LVH (p = 0.02) and greater left atrial diameter (p = 0.03) compared with the control group. In addition, greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found in patients with LVDD grade II compared with LVDD grade I. Conclusions: The present study determined, for the first time, the correlation of left atrial enlargement with progressive RV dysfunction in patients with LVDD. (Arq Bras Cardiol. 2019; 112(3):249-257) Keywords: Ventricular Dysfunction Right; Atrial Function/Physiology; Echocardiography/Methods; Blood Pressure; Heart Failure; Stroke Volume. Introduction Morphological and functional interdependence between the two ventricles may be explained by three mechanisms: (1) increase in right ventricular (RV) end-diastolic pressure in response to an increase in the left ventricular (LV) volume; (2) increased LV filling pressure inducing mechanical stress of the muscle fibers common to both ventricles; and (3) humoral factors, including catecholamines, that may regulate ventricular hypertrophy in response to pressure overload of one of the ventricles. 1-4 The function and dimensions of the right ventricle are directly associated with the LV function. Dilatation of the right ventricle and reduction of its contractile strength is usually found in advanced stages of LV dysfunction, reinforcing the close relationship between the two ventricles. 5-7 It is known that in heart failure patients with reduced LV ejection fraction both ventricular dynamic and pressures are altered, affecting the size and function of other cardiac chambers. However, few reports exist about the relationship between heart failure with preserved LV ejection fraction and increased RV dimensions with reduced systolic function fraction. 4 Also, there are few reports on LV diastolic dysfunction and related findings, such as enlargement of the left atrium (LA), LV hypertrophy (LVH), and their influence on systolic function and RV volume. The LA seems to reflect LV diastolic dysfunction (LVDD), since the parietal tension caused by increased filling pressures leads to dilation of the atrial chamber. 4 In addition, there are no studies specifically evaluating the influence of LA size and LA volume on diameter and function of the right ventricle. Therefore, the aimof the present study was to evaluate the correlation of left atrial volume (LAV) and left atrial diameter with the presence of LVHand RV function and diameter in patients with and without LVDD. Methods Patients This was a cross-sectional cohort study. We studied a convenience sample of 50 consecutive outpatients that underwent transthoracic echocardiogram (TTE) with 249