ABC | Volume 112, Nº3, March 2019

Original Article Baroncini et al Right ventricle and left atrial volume Arq Bras Cardiol. 2019; 112(3):249-257 quantification of LV diastolic function, left atrial diameter and LAV, and RV systolic function and diameter at public healthcare centers. Patients on both sexes, aged older than 18 years, and of any ethnicity, referred for TTE by assistant physicians for any cause were selected. Exclusion criteria were presence of global (ejection fraction < 52% for men and < 54% for women) or segmental LV systolic dysfunction, infiltrative diseases, pericardial diseases, chronic obstructive pulmonary disease, asthma, moderate-to-severe valve diseases with hemodynamic repercussion, interatrial or interventricular septal defects, conditions that impaired the analysis of LV diastolic function (valve diseases with hemodynamic repercussion, atrial fibrillation at the electrocardiogram, definite pacemaker), presence of complete left or right bundle‑branch block at the electrocardiogram and patients with LV diastolic dysfunction grade III. The following clinical data were collected: age, sex, weight, height, body mass index, presence of systemic arterial hypertension (SAH), diabetes mellitus (DM), coronary artery disease (CAD), smoking status (current or former smokers) and dyslipidemia. SAH, DM, dyslipidemia and smoking status were either collected from patients’ medical records or self‑reported by patients. The diagnosis of SAH was defined by systolic and diastolic blood pressure ≥ 140 mmHg and 90 mmHg, respectively, on two or more occasions, or use of anti‑hypertensive drugs; 8 and DM diagnosis was confirmed by: (1) symptoms of polyuria, polydipsia, weight loss and casual (at any time of day, regardless of the time since last meal) glucose > 200 mg/dL; and (4) glycated hemoglobin A1c ≥ 6.5% or use of hypoglycemiant agents or insulin. 9 Dyslipidemia was defined according to the V Brazilian Guidelines on Dyslipidemias and Prevention of Atherosclerosis 10 criteria – total cholesterol > 200 mg/dL, high density lipoprotein cholesterol (HDL) < 40 mg/dL for men and < 50 for women, low density lipoprotein cholesterol (LDL) >160mg/dL, triglycerides >150mg/dL or use of lipid lowering drugs. The presence of CAD was confirmed by data from the medical records including: non-fatal myocardial infarction and surgical or percutaneous myocardial revascularization. All patients signed the informed consent form in duplicate and kept one of the copies. The study was approved by the local ethics committee. Echocardiographic assessment Echocardiographic assessments with harmonic imaging were performed using the IE33 TM (Phillips), Envisor TM (Phillips) and Vivid TM (GE) equipment. The tests were conducted by two echocardiographers experienced in TTE. The following parameters were collected for analysis: LV diastolic function (normal, grade I and grade II), presence of concentric or eccentric LVH, LAV, and RV systolic function measurements. Linear dimensions of the left atrial size were visualized from a parasternal long-axis window with two-dimensional and M-mode views. LAV was estimated using apical four- and two‑chamber views, according to current recommendations. 5-8 Only highly related variables were used for the LV diastolic function analysis to avoid false positive results - the peak early filling (E wave) and late diastolic filling (A wave) velocities (the E/A ratio) <0.8; tissue Doppler imaging measured from the septal or lateral annulus (e’ velocities) (septal < 7 cm/s and lateral < 10 cm/s); average E/e’ ratio > 14; LAV index obtained from four- and two-chamber views > 34 mL/m 2 ; and peak tricuspid regurgitation velocity > 2.8m/s. Classification of diastolic dysfunction was based on the analysis of the transmitral flow. A diastolic dysfunction grade I was defined as an E/A ratio < 0.8 and an E-wave < 50 cm/s, and dysfunction grade III defined as an E/A ratio >2. In case of an E/A ratio < 0.8 and E-wave velocity > 50 cm/s, or an E/A ratio between 0.8 and 2, other parameters were used for the evaluation: velocity of mitral regurgitation, LAV, and E/e’ ratio, according to current guidelines. 11 LVHwas categorized into concentric (increased LV mass index and increased relative wall thickness) and eccentric (increased LV mass index and normal relative wall thickness), according to relative wall thickness (normal <0.42) and indexed LV mass (normal < 95 mg/m² for women and < 115 mg/m² for men), according to current recommendations. 5 Diameter of the right ventricle was measured in the parasternal long-axis window between the RV anterior wall and the interventricular septum in the ventriculo-aortic junction. 5-7 Two parameters were considered in the systolic function analysis: tricuspid annular plane systolic excursion (TAPSE) with M-mode (normal > 16 mm) and lateral S’ wave velocity by tissue Doppler imaging (normal > 9.5 cm). 5-7 Patients were then divided into two groups: individuals with normal LV diastolic function (n = 25) (control group) and individuals with LVDD grade I and II (n = 25) (study group). Statistical analysis Quantitative variables were described as mean and standard deviation, median and interquartile ranges. Categorical variables were described as frequency and percentages. The Student’s t-test was used for two-group comparisons of quantitative variables, and the Fisher’s exact test used for categorical variables. Associations between variables were determined using the Pearson correlation coefficient. Normality of distribution of quantitative variables was tested by the Kolmogorov-Smirnov test. P-values < 0.05 were considered statistically significant. All data were analyzed using the IBM SPSS Statistics software v.20.0 (Armonk, NY). Results Mean age of the control group was 49.9 ± 16.3 years and 52% of the individuals were men. Mean age of the study group was 67.1 ± 10.6 years (p < 0.001), 40% were men. A higher prevalence of SAH was seen in the study group than in the control group. Other clinical characteristics of participants are described in Table 1. The following variables showed normal distribution: TAPSE, lateral S’ velocity, RV diastolic diameter, left atrial size and LAV. A higher incidence of LVH (concentric and eccentric) and a higher left atrial diameter were observed in the study group compared with the control group; no other differences were found between the groups (Tables 2 and 3). Considering the study group, patients with LVDD grade II showed significantly greater left atrial diameter and LAV compared with those with LVDD grade I, with no significant changes in the other parameters (Table 4). The type of LVH (concentric or eccentric) had no effect on the LA or other echocardiographic parameters (Table 4). There was a significant correlation of TAPSE and 250