Left atrial strain as a predictor of left ventricular filling pressures in coronary artery disease with preserved ejection fraction: a comprehensive study with left ventricular end-diastolic and pre-atrial contraction pressures.

Assessing left ventricular (LV) filling pressure (LVFP) is challenging in patients with coronary artery disease (CAD) and preserved LV ejection fraction (LVEF). We aimed to correlate left atrial strain (LAS) with two invasive complementary parameters of LVFP and compared its accuracy to other echocardiographic data to predict high LVFP. This cross-sectional, single-center study enrolled 81 outpatients with LVEF > 50% and significant CAD from a database. Near-simultaneous echocardiography and invasive measurements of both LV end-diastolic pressure (LVEDP) and LV pre-atrial contraction (pre-A) pressure were performed in each patient, based on the definition of LVEDP > 16 mmHg and LV pre-A > 12 mmHg as high LVFP. A moderate to strong correlation was observed between LAS reservoir (LASr), contractile strain, and LVEDP (r: 0.67 and 0.62, respectively; p < 0.001); the same was true for LV pre-A (r: 0.65 and 0.63, respectively; p < 0.001). LASr displayed good diagnostic performance to identify elevated LVFP, which was higher when compared to traditional parameters. Median value of LASr was higher for an isolated increase of LVEDP than for simultaneously high LV pre-A. The cutoff found to predict high LVFP was lower for LV pre-A than that one for LVEDP. In the current study, LASr did not provide an additional contribution to the 2016 diastolic function algorithm. LAS is a valuable tool for predicting LVFP in patients with CAD and preserved LVEF. The choice of LVEDP or LV pre-A as the representative marker of LVFP leads to different cutoffs to predict high pressures. The best strategy for adding this tool to a multiparametric algorithm requires further investigation.

LEFT ATRIAL FUNCTION AND VOLUME BY MAGNETIC RESONANCE IN PATIENTS WITH HEREDITARY AMYLOIDOSIS.

BACKGROUND: Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]). METHODS: All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated. RESULTS: Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions. CONCLUSIONS: Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Left atrial function and volume by magnetic resonance in patients with hereditary amyloidosis

ABSTRACT Background Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]) Methods All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated Results Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions Conclusions Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Strain de la aurícula izquierda por speckle tracking: descripción de protocolo para su medición "paso a paso"

En base a la evidencia disponible y a la experiencia de trabajo en la cohorte del estudio GEnotipo, Fenotipo y Ambiente de la HiperTensión arterial en el UruguaY (GEFA-HT-UY) se describe un protocolo "paso a paso" para la adquisición y medición de strain de la aurícula izquierda, tanto de forma global como para un análisis segmentario tipo "ojo de buey", mediante ecocardiografía bidimensional con speckle tracking.

Summary: Based on the available evidence and work experience of the GEnotipo, Fenotipo y Ambiente de la HiperTensión arterial en el UruguaY (GEFA-HT-UY) cohort, a "step by step" protocol for the acquisition and measurement of the left atrial strain is described, both as a global and segmentary analysis ("bull's eye" like ) using two-dimensional speckle tracking echocardiography.

Baseado nos elementos disponíveis e a experiência de trabalhar na coorte do estudo GEnotipo, Fenotipo y Ambiente de la HiperTensión arterial en el UruguaY (GEFA-HT-UY) se descreve um protocolo de "passo a passo" para a aquisição e a medição do strain da aurícula esquerda, tanto em forma global como pra uma análise segmentar tipo "olho de boi", usando a ecocardiografia bidimensional com speckle tracking.

Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome.

BACKGROUND: Left ventricular diastolic function is an important prognostic marker in acute coronary syndrome. However, classification of the dysfunction grade using isolated echocardiographic parameters remains difficult. Therefore, it is necessary to combine multiple data in diagnostic algorithms. The purpose of this study was to evaluate the capacity of left atrial strain (LAS) components to classify left ventricular diastolic dysfunction (DD) grade. METHODS: Cross-sectional study with 109 consecutive patients admitted to the emergency room with acute coronary syndrome. Patients were referred for echocardiographic evaluation within 72 h. Mean values of LAS, corresponding to three phases of atrial function (reservoir, conduit and contraction), were obtained by speckle-tracking echocardiography. Patients were divided according to the diastolic dysfunction grade for later association with the LAS. RESULTS: The three LAS components showed moderate correlation with most diastolic variables (left atrial volume index, E/e' ratio and e' wave). In addition, there was related reduction of the LAS, which was inversely proportional to the DD grade (p < 0.05). LAS was effective for the identification of patients with DD grade III [area under the curve (AUC) for the reservoir = 0.99; conduit AUC = 0.89; contraction AUC = 0.99) and also those with DD grade II or III (reservoir AUC = 0.94; conduit AUC = 0.92; contraction AUC = 0.80]. CONCLUSIONS: LAS alone presented excellent capacity to classify DD in patients with acute coronary syndrome and may represent an additional tool for this purpose.

Valoración de la función auricular izquierda con el empleo del análisis de la deformidad miocárdica por speckle tracking / A avaliação da função do átrio esquerdo com o uso de análise de deformidade do miocárdio por specke tracking / Assessment of left atrial function with the use of analysis of myocardial deformity specke tracking

Introducción. El tamaño y la función de la aurícula izquierda (AI) son predictores de mal pronóstico. Nuevas técnicas ecocardiográficas permiten evaluar la función global y regional de la AI. Objetivo. Comparar la función de la AI utilizando la deformidad miocárdica auricular (DMA) en pacientes con dilatación de la AI y sujetos controles. Métodos. Estudio prospectivo, en mayores de 18 años, estudiados entre Julio y Diciembre de 2013. Se registraron datos epidemiológicos y se tomaron medidas ecocardiográficas en modo M y Doppler y speckle tracking. Resultados. Se estudiaron 50 pacientes divididos en 2 grupos: AI dilatada (A) y AI normal (B). Hubo una correlación lineal significativa entre el área y el volumen de la AI en el grupo A y diferencias significativas en el strain longitudinal global entre ambos grupos. El strain de la AI fue mayor en el grupo B. Hubo una correlación lineal inversa significativa en el grupo A entre la velocidad, strain y strain rate globales con el volumen de la AI. Conclusiones. El aumento del volumen de la AI se asoció a una disminución de la función de reservorio de la AI. La DMA nos permite una evaluación regional y global no invasiva y confiable de la función auricular izquierda.

Introduction. The size and function of the left atrium (LA) are predictors of poor prognosis. New echocardiographic techniques allow the assessment of global and regional function of the LA. Objective. To compare the role of LA using atrial myocardial deformation (AMD) in patients with dilatation of LA and in control subjects. Methods. This is a prospective study in 50 patients over 18 years, studied between July and December 2013. Epidemiological data were recorded and echocardiographic measurements were taken in M mode, Doppler and speckle tracking. Results. The 50 patients were divided into two groups: dilated LA (A) and normal LA (B) were studied. There was a significant linear correlation between the area and volume of the LA in A group and significant differences in the global longitudinal strain between the two groups. The percentage of AMD was higher in B group. There was a significant inverse linear correlation in A group, between velocity, global strain and global strain with the LA volume. Conclusions. The increase in LA volume was associated with a decreased function of reservoir of LA. The AMD allows us to assess the regional and global non-invasive of LA early dysfunction.

Introdução. O tamanho e a função do átrio esquerdo (AE) são preditores de pior prognóstico. Novas técnicas de ecocardiografia permitem avaliação da função global e regional do AE. Objetivo. Comparar o papel do AE usando deformação do miocárdio atrial (DMA) em pacientes com AE dilatados e indivíduos controle. Métodos. Estudo prospectivo em 50 pacientes com mais de 18 anos, estudados entre Julho e Dezembro de 2013. Os dados epidemiológicos foram registrados e as medidas ecocardiográficas foram tomadas em modo M com Doppler e specke tracking. Resultados. Foram estudados 50 pacientes divididos em dois grupos: AE dilatado (A) y AE normal (B). Houve uma correlação linear significativa entre a área e o volume do AE no grupo A e diferenças significativas na deformação longitudinal global entre os dois grupos. O strain de AE foi maior no grupo B. Houve uma correlação linear inversa significativa no grupo A entre a velocidade, strain e strain rate globais com o volume do AE. Conclusões. O aumento no volume do AE foi associado com uma diminuição da função de reservatório do AE. A DMA permite uma avaliação regional e global não-invasivo e confiável da função atrial esquerda.

Valoración de la función auricular izquierda con el empleo del análisis de la deformidad miocárdica por speckle tracking / Assessment of left atrial function with the use of analysis of myocardial deformity specke tracking / A avaliaþÒo da funþÒo do átrio esquerdo com o uso de análise de deformidade do miocárdio por specke tracking

Introducción. El tamaño y la función de la aurícula izquierda (AI) son predictores de mal pronóstico. Nuevas técnicas ecocardiográficas permiten evaluar la función global y regional de la AI. Objetivo. Comparar la función de la AI utilizando la deformidad miocárdica auricular (DMA) en pacientes con dilatación de la AI y sujetos controles. Métodos. Estudio prospectivo, en mayores de 18 años, estudiados entre Julio y Diciembre de 2013. Se registraron datos epidemiológicos y se tomaron medidas ecocardiográficas en modo M y Doppler y speckle tracking. Resultados. Se estudiaron 50 pacientes divididos en 2 grupos: AI dilatada (A) y AI normal (B). Hubo una correlación lineal significativa entre el área y el volumen de la AI en el grupo A y diferencias significativas en el strain longitudinal global entre ambos grupos. El strain de la AI fue mayor en el grupo B. Hubo una correlación lineal inversa significativa en el grupo A entre la velocidad, strain y strain rate globales con el volumen de la AI. Conclusiones. El aumento del volumen de la AI se asoció a una disminución de la función de reservorio de la AI. La DMA nos permite una evaluación regional y global no invasiva y confiable de la función auricular izquierda.(AU)

Introduction. The size and function of the left atrium (LA) are predictors of poor prognosis. New echocardiographic techniques allow the assessment of global and regional function of the LA. Objective. To compare the role of LA using atrial myocardial deformation (AMD) in patients with dilatation of LA and in control subjects. Methods. This is a prospective study in 50 patients over 18 years, studied between July and December 2013. Epidemiological data were recorded and echocardiographic measurements were taken in M mode, Doppler and speckle tracking. Results. The 50 patients were divided into two groups: dilated LA (A) and normal LA (B) were studied. There was a significant linear correlation between the area and volume of the LA in A group and significant differences in the global longitudinal strain between the two groups. The percentage of AMD was higher in B group. There was a significant inverse linear correlation in A group, between velocity, global strain and global strain with the LA volume. Conclusions. The increase in LA volume was associated with a decreased function of reservoir of LA. The AMD allows us to assess the regional and global non-invasive of LA early dysfunction.(AU)

IntroduþÒo. O tamanho e a funþÒo do átrio esquerdo (AE) sÒo preditores de pior prognóstico. Novas técnicas de ecocardiografia permitem avaliaþÒo da funþÒo global e regional do AE. Objetivo. Comparar o papel do AE usando deformaþÒo do miocárdio atrial (DMA) em pacientes com AE dilatados e indivíduos controle. Métodos. Estudo prospectivo em 50 pacientes com mais de 18 anos, estudados entre Julho e Dezembro de 2013. Os dados epidemiológicos foram registrados e as medidas ecocardiográficas foram tomadas em modo M com Doppler e specke tracking. Resultados. Foram estudados 50 pacientes divididos em dois grupos: AE dilatado (A) y AE normal (B). Houve uma correlaþÒo linear significativa entre a área e o volume do AE no grupo A e diferenþas significativas na deformaþÒo longitudinal global entre os dois grupos. O strain de AE foi maior no grupo B. Houve uma correlaþÒo linear inversa significativa no grupo A entre a velocidade, strain e strain rate globais com o volume do AE. Conclus§es. O aumento no volume do AE foi associado com uma diminuiþÒo da funþÒo de reservatório do AE. A DMA permite uma avaliaþÒo regional e global nÒo-invasivo e confiável da funþÒo atrial esquerda.(AU)

Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography.

BACKGROUND: Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects. METHODS: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated. RESULTS: Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol-max reduction were preoperative diastolic blood pressure (coefficient = -0.004; P = 0.02), lateral mitral annular early diastolic velocity (e') (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = -0.035; P < 0.001). Furthermore, e' was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027). CONCLUSION: Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.

Role of LA shape in predicting embolic cerebrovascular events in mitral stenosis: mechanistic insights from 3D echocardiography.

OBJECTIVES: This study was designed to assess the role of left atrial (LA) shape in predicting embolic cerebrovascular events (ECE) in patients with mitral stenosis (MS). BACKGROUND: Patients with rheumatic MS are at increased risk for ECE. LA remodeling in response to MS involves not only chamber dilation but also changes in the shape. We hypothesized that a more spherical LA shape may be associated with increased embolic events due to predisposition to thrombus formation or to atrial arrhythmias compared with an elliptical-shaped LA of comparable volume. METHODS: A total of 212 patients with MS and 20 control subjects were enrolled. LA volume, LA emptying fraction, and cross-sectional area were measured by 3-dimensional (3D) transthoracic echocardiography. LA shape was expressed as the ratio of measured LA end-systolic volume to hypothetical sphere volume ([4/3π r(3)] where r was obtained from 3D cross-sectional area). The lower the LA shape index, the more spherical the shape. RESULTS: A total of 41 patients presented with ECE at the time of enrollment or during follow-up. On multivariate analysis, LA 3D emptying fraction (adjusted odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92 to 0.99; p = 0.028) and LA shape index (OR: 0.73; 95% CI: 0.61 to 0.87; p < 0.001) emerged as important factors associated with ECE, after adjustment for age and anticoagulation therapy. In patients in sinus rhythm, LA shape index remained associated with ECE (OR: 0.79; 95% CI: 0.67 to 0.94; p = 0.007), independent of age and LA function. An in vitro phantom atrial model demonstrated more stagnant flow profiles in spherical compared with ellipsoidal chamber. CONCLUSIONS: In rheumatic MS patients, differential LA remodeling affects ECE risk. A more spherical LA shape was independently associated with an increased risk for ECE, adding incremental value in predicting events beyond that provided by age and LA function.

Left atrial and left ventricular diastolic function in chronic Chagas disease.

BACKGROUND: Left atrial (LA) and left ventricular (LV) diastolic function analysis can yield new strategies to recognize early cardiac involvement and prognostic indicators in Chagas disease. METHODS: Patients with Chagas disease with the indeterminate (n = 69) or with the cardiac form (32 with changes limited to electrocardiography [stage A], 25 with changes in LV systolic function but no heart failure [HF; stage B], and 26 with HF) underwent evaluation of LV diastolic function (mitral inflow, pulmonary vein flow, color M-mode echocardiography, and tissue Doppler analysis), and LA function by three-dimensional echocardiography and strain analysis and were prospectively followed for the occurrence of clinical events. Echocardiograms were also obtained from 32 controls. RESULTS: LV diastolic dysfunction was gradually more prevalent and severe across groups from patients with the indeterminate form of Chagas disease to patients with HF. Tissue Doppler was the best tool to demonstrate the worsening of LV diastolic function across the groups (E' velocity: controls, 12.6 ± 2.3 cm/sec; patients with the indeterminate form, 12.1 ± 3.1 cm/sec; stage A, 10.3 ± 2.9 cm/sec; stage B, 8.3 ± 2.8 cm/sec; patients with HF, 5.6 ± 1.9; P < .0001). Although maximum LA volume was increased only in patients with HF, minimum LA volume (controls, 8 ± 2 mL/m(2); patients with the indeterminate form, 8 ± 2 mL/m(2); stage A, 9 ± 3 mL/m(2); stage B, 11 ± 4 mL/m(2); patients with HF, 27 ± 17 mL/m(2); P < .0001) and precontraction LA volume (controls, 11 ± 3 mL/m(2); patients with the indeterminate form, 12 ± 3 mL/m(2); stage A, 13 ± 4 mL/m(2); stage B, 16 ± 5 mL/m(2); patients with HF, 32 ± 19 mL/m(2); P < .0001) were increased in all cardiac form groups. LA conductive function was depressed in all cardiac form groups, while LA contractile function was depressed only in patients with HF. Cox proportional-hazards regression analysis revealed that end-systolic LV diameter (hazard ratio, 1.6; 95% confidence interval, 0.9-2.8; P = .09), E' velocity (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8; P = .001), and peak negative global LA strain (hazard ratio, 1.21; 95% confidence interval, 1.02-1.4; P = .03), were independent predictors of clinical events. CONCLUSIONS: LV diastolic dysfunction was found in all forms of chronic Chagas disease, including those without LV systolic dysfunction. LV diastolic dysfunction may contribute to changes in LA volume and conductive function found in early stages of the cardiac form. Both LV diastolic function and LA contractile function were independent predictors of clinical events.

Alterações precoces da função diastólica do ventrículo esquerdo e da função do átrio esquerdo na doença de chagas detectadas ao doppler tecidual e por novos índices ecocardiográficos: Ecocardiografia tridimensional e deformação miocárdica / Early changes in diastolic function of the left ventricle and left atrium function in Chagas disease detected by tissue Doppler echocardiographic indices and new: Three-dimensional echocardiography and myocardial deformation

Fundamento: A doença de Chagas ainda é importante problema de saúde pública na América Latina onde 12 a 15 milhões de pessoas são infectadas pelo Trypanosoma cruzi. A forma crônica cardíaca apresenta alta morbimortalidade. A disfunção diastólica do ventrículo esquerdo (VE) está presente em diferentes estágios da doença de Chagas e o seu diagnóstico pode ser uma estratégia para o reconhecimento precoce do acometimento cardíaco na doença de Chagas. Objetivos: Analisar a função diastólica do VE e a função do AE em pacientes na fase crônica da doença de Chagas sem acometimento global ou segmentar da função sistólica do VE. Métodos: Pacientes com doença de Chagas entre 18 e 60 anos de idade foram consecutivamente analisados no período de março de 2010 a agosto de 2011. Ecocardiogramas de 52 pacientes sem lesão cardíaca aparente, 29 no estágio A da fase cardíaca (alterações apenas no eletrocardiograma) e 25 controles foram analisados. A função diastólica do VE foi analisada pelo fluxo mitral, fluxo de veia pulmonar, velocidade de propagação ao modo M colorido, untwist do VE e Doppler tecidual do anel mitral. A função do AE foi avaliada pela ecocardiografia tridimensional e pela análise de deformação bidimensional...

Resultados: Todos os grupos tinham idade e massa corpórea similar. Todos os grupos tinham diâmetros cavitários, massa do VE e função sistólica do VE similares. A disfunção diastólica foi mais prevalente em pacientes no estágio A que em pacientes sem envolvimento cardíaco aparente. Os parâmetros derivados do Doppler tecidual foram os melhores para discriminar o grau de disfunção diastólica entre os grupos. A razão EE foi progressivamente maior e a razão EA foi progressivamente menor de controles, para indeterminados e pacientes no estágio A. Os volumes do AE foram maiores em pacientes no estágio A, porém as frações de esvaziamento do AE foram similares entre os grupos. O pico positivo do do AE foi menor no estágio A enquanto que os outros parâmetros do do AE não diferiram entre os grupos. Conclusões: Pacientes com doença de Chagas e função sistólica do VE preservada apresentam disfunção diastólica, a qual é mais prevalente em pacientes no estágio A. O Doppler tecidual é o melhor índice para identificar a diferença na função diastólica entre os grupos estudados. Apenas a função condutiva do AE estava deprimida em pacientes no estágio A da fase cardíaca da doença de Chagas. Novos estudos são necessários para definir o valor prognóstico dos achados dessa Tese...

Função diastólica e volume atrial esquerdo em obesas com e sem síndrome metabólica e com pressão de enchimento de ventrículo esquerdo normal pelo Doppler tecidual / Diastolic function and left atrial volume index in obese with and without metabolic syndrome and with normal left atrial filling pressure through tissue Doppler

Introdução: A obesidade na presença ou ausência de síndrome metabólica (SM) prenuncia o aparecimento de doenças cardiovasculares e mortalidade. A medida do índice volumétrico atrial (IVA) esquerdo, em pacientes com pressão de enchimento normal e com poucas alterações na função diastólica, possivelmente pode apresentar alterações estruturais precoces em obesos com ou sem (SM). Objetivo: Este estudo propôs avaliar alterações estruturais atriais esquerdas, em grupo de obesos, com e sem (SM) e com pressão de enchimento normalpela relação E/e´. Foram incluídos, somente, pacientes com teste de esforço e história clínica negativa para coronariopatia. Material e métodos: Estudo transversal observacional incluiu, de forma consecutiva, 77 pacientes, assim distribuídos: 17 estróficos, 28 sem (SM), 32 com (SM). Exames metabólicos, ecocardiograma e teste de esforço foram realizados dentro do mesmo mês. As medidas ecocardiográficas seguiram as normas da Sociedade Americana de Ecocardiografia. O teste de esforço foi realizado de acordo com o protocolo de Bruce. A classificação do perfil metabólico seguiu as normas da ATP III. Resultados: O (IVA) esquerdo associou-se, pela analise de regressão múltipla, com HDL (β=0,3) colesterol total (β=0,08), TRIV (β=-0,1), TD (β=0,1), onda E (β=0, 3), onda s (β= -0,6). p<0,05 Analise univariada, pressão arterial sistólica e diastólica (r=0,5), onda e´ (r= -0,5), E/e´ (r=0,5), TD (r=0,6), IMC e cintura abdominal (r=0,3), p<0,05. Conclusão: O (IVA) esquerdo encontrou-se alterado, em obesos com síndrome metabólica, com discretas alterações da função diastólica. Fatores não hemodinâmicos poderiam estar associados às alterações do (IVA) esquerdo.

Obesity predicts the oncoming of cardiovascular disease and mortality either in the presence or absence of metabolic syndrome. Themeasurement of the left atrial volume in patients with normal filling pressure, and with a few alterations in diastolic function, can possibly present premature structural changes in obese patients with or without MS. Objective: The purpose of this study was to investigatestructural changes in the left atrial in a group of obese patients with and without normal filling pressure by E /e´. It was included only patients who underwent treadmill test, and negative clinical history for coronary disease. Material and methods: A Cross-sectional (observational) study included consecutively 77 patients distributed as follows: 17 eutrophic, 28 without MS, 32 with MS. Metabolic tests, echocardiogram and stress test were performed in the month of their completion. Echocardiographic measurements followed the rules ofthe American Society of Echocardiography. The treadmill test was performed according to the Bruce protocol. The classification of themetabolic profile followed the rules of the ATP III. Results: The left (AVI) was associated through multiple regression analysis with HDLβ=0,3 , cholesterol total β= 0.08, TRIV β= - 0.1, TD β= 0.1,E β= 0.3, s basal lateral wall β=- 0.6 .p<0.05. (AVI) by means of univariate analysis had been associated with arterial systolic and diastolic pressure R=0.5, basal lateral wall e´ R=- 0.5, E/e´ R=0.5, TD R= 0.6 and IMC and waist circumference R=0.3. p<0.05. Conclusion: The left IVA was altered in obese patients with MS, with rates of relaxation and filling pressure within normal limits. Non hemodynamic factors might be associated with these early changes of left IVA.