IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190043 Introduction Left atrial volume indexed to body surface area (LAV/ BSA) provides accurate assessment of LA size, serving as a referenceandanexcellentmarkerofthediastolicdysfunction chronicity, cardiovascular risk, left ventricular (LV) filling pressure and, above all, of the morphophysiologic expression of LV diastolic dysfunction. 1-2 LAV has been used to grade the progressive impairment of LV diastolic function (Figure 1). 3 It is also a well-validated echocardiographic parameter for differential diagnosis of heart failure with a normal ejection fraction (HFNEF). 4 Vitamin D has been associated with cardiovascular disease, especially regarding the pathophysiology of heart failure (HF). 5 Studies associating hypovitaminosis D with parameters of morphofunctional changes are still controversial in the literature, both in relation to the circulating levels and the type of supplementation. 6 508 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(5):508-516 Mailing Address: Erica de Abreu Macedo Av. Nossa Senhora de Copacabana, 750, apto 712. Postal Code: 22050-000, Copacabana, Rio de Janeiro - Brazil. E-mail: erica_abreu@hotmail.com Increased Left Atrial Volume and Its Relationship to Vitamin D in Primary Care Erica de Abreu Maced o, Maria Luiza Garcia Ros a, A ntônio José Lagoeiro Jorg e, Adson Renato Leit e, L eivys Henrique Silva Santo s, J uliana Salge Vieir a Universidade Federal Fluminense, Niterói, RJ – Brazil Manuscript received November 07, 2017; revised manuscript September 02, 2018; accepted November 01, 2018. Abstract Background: The study is based on the fact that left atrial (LA) volume measurement is a marker of the presence of diastolic dysfunction and that Vitamin D deficiency may be associated with ventricular remodeling, worsening of left ventricular (LV) diastolic and systolic function, and activation of the renin-angiotensin- aldosterone system. Objective: To evaluate whether LAV changes are related to vitamin D deficiency. Method: A cross-sectional, population-based, unicentric study in which 640 patients over 45 years of age enrolled in the Niterói's Médico de Família program, RJ, were evaluated. Patients were submitted to tissue Doppler echocardiography to evaluate the parameters of diastolic and systolic function and vitamin D dosage. The presence or absence of hypovitaminosis D associated with structural and functional cardiac changes was compared between each group. A p < 0.05 value was considered as an indicator of statistical significance. Results: Of the 640 individuals analyzed, hypovitaminosis D was confirmed in 39.2% of the patients, of whom 34.8% had diastolic dysfunction. The most relevant echocardiographic parameters that were statistically significant were non-indexed AEDs and LAV, E'/A' and E wave deceleration time, which were associated with the presence of hypovitaminosis D (P < 0.01). Conclusion: The study of the association of hypovitaminosis D and the appearance of structural and functional cardiac abnormalities may contribute to the discussion of the adoption of one more criterion to select individuals at risk of developing clinical cardiac insufficiency in primary care since, with the use of echocardiography, the subclinical condition of cardiac involvement, with prognostic and treatment implications for the referred patients with hypovitaminosis D, can be identified early. (Int J Cardiovasc Sci. 2019;32(5):508-516) Keywords: Heart Atria; Atrial Function; Cholecalciferol; Primary Health Care; Heart Failure; Echocardiography.