Page 57 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Ageing has been associated with structural changes of the left atrium (LA). Besides
LA dilatation as a marker of chronic left ventricular (LV) diastolic dysfunction,1,2,3
increase in LA myocardial fibrosis has been demonstrated and associated with
impaired LA function, increase in LA stiffness and changes in LA electrophysiological 3 properties.3,4,5 These structural and functional LA changes have been associated with
increased risk of atrial fibrillation and heart failure.6 P-wave indices such as P-wave duration and P-wave dispersion (PWD) indirectly reflect the total conduction time of the LA7. Echocardiographic tissue Doppler imaging (TDI) also permits evaluation of the total atrial conduction time (PA-TDI duration), which reflects the extent of both electrical and structural remodeling of the atria.8 Additionally, two-dimensional speckle tracking echocardiography enables the assessment of LA reservoir strain, a marker of LA compliance.9 PWD, PA-TDI and LA reservoir strain may change due to structural remodeling of the LA. The present study aimed at describing the effect of ageing on LA properties in a cohort of individuals without structural heart disease.
METHODS
A total of 386 patients who were clinically referred for cardiac evaluation and transthoracic echocardiography at the Leiden University Medical Center (The Netherlands) without structural heart disease, were evaluated retrospectively.10,11 Referral reasons included evaluation of dyspnea, chest pain, screening preceding non- cardiac intervention, palpitations and evaluation of patients with high cardiovascular risk profile. Individuals with prior cardiac intervention, known history of coronary artery disease, pacemaker implantation, documented cardiac arrhythmias, resting LV wall motion abnormalities and any grade of valvular stenosis or more than mild valvular regurgitation were excluded. Therefore, only patients with structurally and functionally normal hearts on echocardiography and sinus rhythm on the electrocardiogram (ECG) without conduction abnormalities were included in the present evaluation. Patients were selected in order to obtain approximately equal proportions of gender matched groups across 5 pre-determined age categories: <45 years, 45-54 years, 55-64 years, 65-74 years and >75 years.
Patient demographics and clinical data were collected. Medications including angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, beta- blockers, statins, diuretics and calcium-channel blockers were noted. All clinical data
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