ASSOCIATION OF LEFT ATRIAL VOLUME INDEX WITH DIASTOLIC DYSFUNCTION IN HYPERTENSIVE PATIENTS: A CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL

Abstract

Introduction: Longstanding hypertension frequently leads to an underrecognized condition of left ventricular diastolic dysfunction (LVDD), which often precedes heart failure (HF). Left atrial volume index (LAVI), a surrogate for the cumulative effect of elevated left ventricular filling pressure, has been proposed as an echocardiographic marker of LVDD. Objectives: This study examined the association between LAVI and the presence and severity of LVDD in hypertensive patients. Methodology: In this cross-sectional study, transthoracic echocardiography was performed on 217 hypertensive patients. LAVI was measured by the biplane area–length method and indexed to body surface area. Diastolic function was classified as normal or Grade I–III LVDD using the 2016 ASE/EACVI multiparametric algorithm. Group differences, correlations, multivariable linear and logistic regression, and receiver operating characteristic (ROC) analyses were performed. Results: The mean age was 59.78 ± 14.87 years, and LVDD was present in 148 patients (68.2%). Mean LAVI was 30.85 ± 5.76 mL/m² in participants with normal diastolic function, compared with 29.50 ± 5.70, 44.37 ± 3.05, and 45.04 ± 2.82 mL/m² in Grade I, II, and III LVDD, respectively. LAVI did not differ between normal function and Grade I (p = 0.361) but was substantially higher in Grade II/III than in the normal/Grade I groups (p < 0.001). LAVI correlated strongly with E/e′ (r = 0.771, p < 0.001) and TR velocity (r = 0.754, p < 0.001). In multiple linear regression, E/e′ (β = 0.771, p < 0.001), LA diameter (β = 0.579, p < 0.001), and TR velocity (β = 0.322, p < 0.001) were independently associated with LAVI. In binary logistic regression, E/e′ (OR = 1.660, 95% CI: 1.352–2.040, p < 0.001) was independently associated with LVDD, while BMI showed an inverse association (OR = 0.940, 95% CI: 0.890–0.993, p = 0.026). LAVI showed moderate discriminatory ability for LVDD (AUC = 0.704, 95% CI: 0.637–0.771), with 61.5% sensitivity and 66.7% specificity at a cutoff of 34.0 mL/m². Conclusion: In hypertensive patients, LAVI is associated with more advanced grades of LVDD and correlates with Doppler markers of elevated filling pressure. Its discriminatory ability for LVDD is moderate, supporting its role as one component of a multiparametric assessment rather than a standalone diagnostic test.