Left Atrial Volume, Cardiorespiratory Fitness, and Diastolic Function in Healthy Individuals: The HUNT Study, Norway

Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO ) using ergospirometry, and percent of age- and-sex-predicted VO was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m in 39% of participants, and LAVI was positively associated with VO and percentage of age- and-sex-predicted VO (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO /percentage of age- and-sex-predicted VO showing higher LAVI with advanced age and higher VO /percentage of age- and-sex-predicted VO as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.