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Published in: BMC Cardiovascular Disorders 1/2016

Open Access 01-12-2016 | Research article

Prevalence of left atrial enlargement and its risk factors in general Chinese population

Authors: Qiaoyun Ou, Yintao Chen, Shasha Yu, Xiaofan Guo, Huijie Zhao, Yingxian Sun

Published in: BMC Cardiovascular Disorders | Issue 1/2016

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Abstract

Background

Left atrial enlargement (LAE) has been proven to be significantly related to stroke and cardiovascular diseases. In China, few studies related to LAE have been conducted, especially in the general population. To the best of our knowledge, our study is the first to explore the prevalence of LAE and associated risk factors in the general Chinese population.

Methods

This study included a total of 11,956 subjects aged ≥35 years. All participants completed a questionnaire, and underwent complete physical examination, electrocardiogram (ECG) and echocardiogram. We defined LAE as a LA diameter exceeding 4.0 cm in men and 3.8 cm in women. We conducted a multivariable logistic regression analysis and a linear regression analysis to identify independent factors of LAE.

Results

The overall prevalence of LAE was 6.43 % for subjects aged over 35 years. The prevalence of LAE was 6.78 % in women and 6.02 % in men. The major risk factors of LAE were female sex (odds ration [OR]: 1.229, β: 0.197), advancing age (OR: 1.015, β: 0.036), high systolic blood pressure (OR: 2.331, β: 0.185), high body mass index (BMI) (OR: 3.956, β: 0.373), diabetes (OR: 1.498, β: 0.030), high left ventricular myocardial index (OR: 1.003, β: 0.073), and low left ventricular ejection fraction, low heart rate, and low estimated glomerular filtration rate. Additionally, the association between BMI and LAE was the most obvious.

Conclusions

Female sex, advancing age, high systolic blood pressure, high BMI, diabetes, high left ventricular myocardial index, low estimated glomerular filtration rate, low left ventricular ejection fraction, and low heart rate were proven to be risk factors of LAE.
Literature
1.
go back to reference Levy D, Garrison RJ, Castelli WP, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.CrossRefPubMed Levy D, Garrison RJ, Castelli WP, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.CrossRefPubMed
2.
go back to reference Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. Circulation. 2001;103:2346–51.CrossRefPubMed Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. Circulation. 2001;103:2346–51.CrossRefPubMed
3.
go back to reference Li X, Li R, Yu W, Shi H, Wei L. Characteristics of coronary microvascular lesions in autopsied elderly with hypertensive left ventricular hypertrophy. Chin Med J. 2002;115:658–63.PubMed Li X, Li R, Yu W, Shi H, Wei L. Characteristics of coronary microvascular lesions in autopsied elderly with hypertensive left ventricular hypertrophy. Chin Med J. 2002;115:658–63.PubMed
4.
go back to reference Kizer JR, Bella JN, Palmieri V, Liu JE, Best LG, Lee ET, Roman MJ, Devereux RB. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS). Am Heart J. 2006;151:412–8. Kizer JR, Bella JN, Palmieri V, Liu JE, Best LG, Lee ET, Roman MJ, Devereux RB. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS). Am Heart J. 2006;151:412–8.
5.
go back to reference Tang RB, Yan XL, Dong JZ, Kalifa J, Long DY, Yu RH, Bai R, Kang JP, Wu JH, Sang CH, Ning M, Jiang CX, Salim M, Ma CS. Predictors of recurrence after a repeat ablation procedure for paroxysmal atrial fibrillation: role of left atrial enlargement. Europace. 2014;16:1569–74. Tang RB, Yan XL, Dong JZ, Kalifa J, Long DY, Yu RH, Bai R, Kang JP, Wu JH, Sang CH, Ning M, Jiang CX, Salim M, Ma CS. Predictors of recurrence after a repeat ablation procedure for paroxysmal atrial fibrillation: role of left atrial enlargement. Europace. 2014;16:1569–74.
6.
go back to reference El Aouar LM, Meyerfreud D, Magalhães P, Rodrigues SL, Baldo MP, Brasil Y, El Aouar SM, El Aouar NA, Mill JG, Campos Filho O. Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients. Arq Bras Cardiol. 2013;101:52–8. El Aouar LM, Meyerfreud D, Magalhães P, Rodrigues SL, Baldo MP, Brasil Y, El Aouar SM, El Aouar NA, Mill JG, Campos Filho O. Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients. Arq Bras Cardiol. 2013;101:52–8.
7.
go back to reference Pierdomenico SD, Pierdomenico AM, Di Carlo S, Di Tommaso R, Cuccurullo F. Left atrial enlargement and risk of ischemic stroke in elderly treated hypertensive patients. Am J Hypertens. 2014;27:1179–84.CrossRefPubMed Pierdomenico SD, Pierdomenico AM, Di Carlo S, Di Tommaso R, Cuccurullo F. Left atrial enlargement and risk of ischemic stroke in elderly treated hypertensive patients. Am J Hypertens. 2014;27:1179–84.CrossRefPubMed
8.
go back to reference Shigematsu Y, Norimatsu S, Ogimoto A, Ohtsuka T, Okayama H, Higaki J. The influence of insulin resistance and obesity on left atrial size in Japanese hypertensive patients. Hypertens Res. 2009;32:500–4.CrossRefPubMed Shigematsu Y, Norimatsu S, Ogimoto A, Ohtsuka T, Okayama H, Higaki J. The influence of insulin resistance and obesity on left atrial size in Japanese hypertensive patients. Hypertens Res. 2009;32:500–4.CrossRefPubMed
9.
go back to reference Su G, Cao H, Xu S, Lu Y, Shuai X, Sun Y, Liao Y, Li J. Left atrial enlargement in the early stage of hypertensive heart disease: a common but ignored condition. J Clin Hypertens (Greenwich). 2014;16:192–7. Su G, Cao H, Xu S, Lu Y, Shuai X, Sun Y, Liao Y, Li J. Left atrial enlargement in the early stage of hypertensive heart disease: a common but ignored condition. J Clin Hypertens (Greenwich). 2014;16:192–7.
10.
go back to reference O’Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, O’Malley K, Jamieson M, Altman D, Bland M, Atkins N. The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens. 1990;8:607–19. O’Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, O’Malley K, Jamieson M, Altman D, Bland M, Atkins N. The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens. 1990;8:607–19.
11.
go back to reference Devereux RB, Roman MJ. Evaluation of cardiac and vascular structure by echocardiography and other noninvasive techniques. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, treatment. 2nd ed. New York: Raven; 1995. p. 1969–85. Devereux RB, Roman MJ. Evaluation of cardiac and vascular structure by echocardiography and other noninvasive techniques. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, treatment. 2nd ed. New York: Raven; 1995. p. 1969–85.
12.
go back to reference Sahn DJ, De Maria A, Kisslo J, Weyman AE. The Committee on M-mode Standardization of the American Society of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–83.CrossRefPubMed Sahn DJ, De Maria A, Kisslo J, Weyman AE. The Committee on M-mode Standardization of the American Society of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–83.CrossRefPubMed
13.
go back to reference Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. The American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms: recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2:358–67. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. The American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms: recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2:358–67.
14.
go back to reference Roman MJ, Devereux RB, Kramer-Fox R, O’Loughlin J. Two-dimensional echocardiographic aortic root dimensions in children and adults: biologic determinants and normal limits. Am J Cardiol. 1989;64:507–12.CrossRefPubMed Roman MJ, Devereux RB, Kramer-Fox R, O’Loughlin J. Two-dimensional echocardiographic aortic root dimensions in children and adults: biologic determinants and normal limits. Am J Cardiol. 1989;64:507–12.CrossRefPubMed
15.
go back to reference Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.
16.
go back to reference Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. Recommendations for Chamber Quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. Recommendations for Chamber Quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.
17.
go back to reference Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.
18.
go back to reference Hypertension control. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1996; 862:1–83. Hypertension control. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1996; 862:1–83.
19.
go back to reference Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.CrossRef Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.CrossRef
20.
go back to reference Wang CN, Liang Z, Wei P, Liu P, Yu JX, Zhang DM, Ma FLl. Changes in dietary patterns and certain nutrition-related diseases in urban and rural residents of Jiangsu Province, China, during the 1990s. Biomed Environ Sci. 2002;15:271–6. Wang CN, Liang Z, Wei P, Liu P, Yu JX, Zhang DM, Ma FLl. Changes in dietary patterns and certain nutrition-related diseases in urban and rural residents of Jiangsu Province, China, during the 1990s. Biomed Environ Sci. 2002;15:271–6.
21.
go back to reference Cuspidi C, Negri F, Lonati L, Muiesan ML, Capra A, Milan A, Sala C, Danzi GB, Longo M, Morganti A. Prevalence and correlates of echocardiographic left atrial enlargement in hypertensive outpatients in clinical practice. Clin Exp Hypertens. 2011;33:328–35. Cuspidi C, Negri F, Lonati L, Muiesan ML, Capra A, Milan A, Sala C, Danzi GB, Longo M, Morganti A. Prevalence and correlates of echocardiographic left atrial enlargement in hypertensive outpatients in clinical practice. Clin Exp Hypertens. 2011;33:328–35.
22.
go back to reference Kopeć G, Sobień B, Podolec M, Waligóra M, Brózda M, Zarzecka J, Loster B, Nessler J, Pająk A, Podolec P. The prevalence of abnormal echocardiographic findings in a sample of urban adult population. Kardiol Pol. 2014;72:42–9. Kopeć G, Sobień B, Podolec M, Waligóra M, Brózda M, Zarzecka J, Loster B, Nessler J, Pająk A, Podolec P. The prevalence of abnormal echocardiographic findings in a sample of urban adult population. Kardiol Pol. 2014;72:42–9.
23.
go back to reference Stritzke J, Markus MR, Duderstadt S, Lieb W, Luchner A, Döring A, Keil U, Hense HW, Schunkert H. The aging process of the heart: obesity is the main risk factor for left atrial enlargement during aging. J Am Coll Cardiol. 2009;54:1982–9. Stritzke J, Markus MR, Duderstadt S, Lieb W, Luchner A, Döring A, Keil U, Hense HW, Schunkert H. The aging process of the heart: obesity is the main risk factor for left atrial enlargement during aging. J Am Coll Cardiol. 2009;54:1982–9.
24.
go back to reference Wang SX, Xue H, Zou YB, Sun K, Fu CY, Wang H, and Hui RT. Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese. Chin Med J. 2012;125(1):21–6. Wang SX, Xue H, Zou YB, Sun K, Fu CY, Wang H, and Hui RT. Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese. Chin Med J. 2012;125(1):21–6.
25.
go back to reference Katayama T, Fujiwara N, Tsuruya Y. Factors contributing to left atrial enlargement in adults with normal left ventricular systolic function. J Cardiol. 2010;55:196–204.CrossRefPubMed Katayama T, Fujiwara N, Tsuruya Y. Factors contributing to left atrial enlargement in adults with normal left ventricular systolic function. J Cardiol. 2010;55:196–204.CrossRefPubMed
26.
go back to reference Armstrong AC, Gidding SS, Colangelo LA, Kishi S, Liu K, Sidney S, Konety S, Lewis CE, Correia LC, Lima JA. Association of early adult modifiable cardiovascular risk factors with left atrial size over a 20-year follow-up period: the CARDIA study. BMJ Open. 2014;4, e004001. Armstrong AC, Gidding SS, Colangelo LA, Kishi S, Liu K, Sidney S, Konety S, Lewis CE, Correia LC, Lima JA. Association of early adult modifiable cardiovascular risk factors with left atrial size over a 20-year follow-up period: the CARDIA study. BMJ Open. 2014;4, e004001.
27.
go back to reference Cuspidi C, Negri F, Sala C, Valerio C, Mancia G. Association of left atrial enlargement with left ventricular hypertrophy and diastolic dysfunction: a tissue Doppler study in echocardiographic practice. Blood Press. 2012;21:24–30.CrossRefPubMed Cuspidi C, Negri F, Sala C, Valerio C, Mancia G. Association of left atrial enlargement with left ventricular hypertrophy and diastolic dysfunction: a tissue Doppler study in echocardiographic practice. Blood Press. 2012;21:24–30.CrossRefPubMed
28.
go back to reference Hirst K. Alterations in left ventricular, left atrial and right ventricular structure and function to cardiovascular risk factors in adolescents with type 2 diabetes participating in the today clinical trial. Pediatr Diabetes. 2015;16:39-47 Hirst K. Alterations in left ventricular, left atrial and right ventricular structure and function to cardiovascular risk factors in adolescents with type 2 diabetes participating in the today clinical trial. Pediatr Diabetes. 2015;16:39-47
Metadata
Title
Prevalence of left atrial enlargement and its risk factors in general Chinese population
Authors
Qiaoyun Ou
Yintao Chen
Shasha Yu
Xiaofan Guo
Huijie Zhao
Yingxian Sun
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2016
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-016-0229-z

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