Diastolic dysfunction and left atrial volume
Atrial remodeling and DD
Although previous studies have established the association of CV disease and LV remodeling with LA enlargement, the mechanism whereby CV disease and LV remodeling results in LA remodeling has not been conclusively defined. Atrial myopathy independent of ventricular dysfunction could lead to LA remodeling independent of hemodynamic load. Volume overload secondary to mitral regurgitation and elevated LV filling pressures in patients with reduced EF are well recognized to be associated with LA enlargement. However, in patients with normal systolic function and without mitral regurgitation, those factors mediating LA remodeling are less clear.
In the general population, atrial remodeling as assessed by LAVi is closely associated with the severity of DD, a relationship that persists after adjustment for pertinent clinical and echocardiographic covariates. However, LAVi does not reliably predict milder but prognostically important degrees of DD, and the severity of DD is most predictive of future death.