CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 49 deformation and this may result in an age-related decrease in RALS. However, we did not perform biomarkers or CMR imaging to objectively assess for the presence of fibrosis in this study. The trend towards gender differences with RALS, although not statistically relevant, could be multifactorial in this study. In addition to a difference in biology, a higher BMI in females compared to males may explain these findings. Male participants were also younger and had higher RAVI and likely more compliant RA compared to females, which translated into higher RALS. Furthermore, males had a lower heart rate compared to females [65.0 (59.0–76.5) vs 76.0 (67.0–82.5) beats/min, p = 0.002], which allowed for a prolonged filling time of the RA chamber and therefore increased stretch of the RA wall, with the resultant higher RALS. Padeletti et al. did not find differences in RALS with regard to gender and ageing.10 This lack of association between RALS, gender and aging may be related to the limited capacity of the software in identifying all the segments of the RA due to the higher tricuspid annulus deformation compared to the mitral valve. Furthermore, this may be attributed to varying sample sizes and racial differences in the two studies. Table 4. Clinical and echocardiographic indices according to body mass index Variables BMI kg/m2 (n = 100) BMI < 25 kg/m2 (n = 32) BMI 25 to < 30 kg/m2 (n = 23) BMI ≥ 30 kg/m2 (n = 44) p-value* (ANOVA)# Clinical parameters Age (years) 37.5 (29.0–48.0) 30.0 (24.5–38.5) 40.0 (30.0–48.0) 44.0 (34.0–51.0) < 0.001 Weight (kg) 73.0 (65.0–85.0) 63.3 (57.0–65.8) 68.0 (66.0–77.6) 86.5 (82.0–99.5) < 0.001 Female, n (%) 60 (60.0) 10 (31.3) 15 (65.2) 34 (77.3) 0.078 Body surface area (m2) 1.8 ± 0.2 1.7 ± 0.1 1.7 ± 0.1 1.9 ± 0.2 0.069 Systolic blood pressure (mmHg) 126.8 ± 12.4 123.6 ± 12.9 128.1 ± 10.7 128.5 ± 12.8 0.598 Diastolic blood pressure (mmHg) 79.3 ± 10.3 76.6 ± 10.8 79.3 ± 10.8 81.2 ± 9.7 0.760 Heart rate (bpm) 72.0 (62.5–82.0) 65.5 (58.0–77.0) 65.0 (57.0–81.0) 77.0 (70.5–82.5) 0.002 RA parameters RA volume (ml) 34.8 ± 10.7 35.1 ± 11.6 30.7 ± 9.2 36.7 ± 10.2 0.513 RA volume index (ml/m2) 19.5 ± 5.7 20.8 ± 5.9 18.0 ± 5.9 19.4 ± 5.4 0.822 RA length (mm) 44.5 ± 5.2 42.9 ± 5.7 43.4 ± 4.0 46.2 ± 5.0 0.226 RA width (mm) 36.3 ± 5.6 37.2 ± 5.5 33.2 ± 5.1 37.3 ± 5.8 0.817 RALS (%) 32.7 ± 10.5 35.7 ± 9.3 34.6 ± 11.4 29.9 ± 10.1 0.571 RV functional parameters TAPSE (mm) 19.0 (17.0–22.0) 19.0 (17.0–22.5) 19.0 (16.0–23.2) 18.5 (17.0–21.5) 0.898 PASP (mmHg) 15.0 (13.5–20.0) 15.0 (15.0–25.0) 17.5 (15.0–20.0) 15.0 (12.0–18.0) 0.091 RV E′ (cm/s) 11.0 (8.9–13.0) 12.0 (10.1–13.6) 11.7 (8.9–13.6) 10.2 (8.0–11.6) 0.114 RV A′ (cm/s) 9.7 (8.4–12.1) 9.0 (7.6–11.8) 10.2 (8.7–11.3) 10.3 (8.8–13.0) 0.081 RV E′/ A′ 1.1 (0.8–1.4) 1.2 (0.9–1.6) 1.0 (0.8–1.5) 0.9 (0.7–1.2) 0.020 LV measurements LV systolic diameter (mm) 29.0 (26.0–31.5) 29.5 (25.5–32.0) 29.0 (26.0–30.0) 29.0 (26.0–32.0) 0.730 LV diastolic diameter (mm) 42.3 ± 5.1 42.1 ± 5.2 42.5 ± 4.7 42.4 ± 5.3 0.824 End-diastolic volume index (ml/m2) 86.2 ± 23.1 88.0 ± 23.3 88.6 ± 24.6 84.0 ± 22.7 0.913 End-systolic volume index (ml/m2) 18.2 (14.5–22.6) 20.0 (16.1–23.5) 18.1 (15.3–19.9) 17.1 (13.4–21.1) 0.220 LA volume index (ml/m2) 21.5 (15.2–26.4) 20.1 (13.0–23.8) 22.6 (16.7–25.8) 22.8 (16.2–30.5) 0.242 LA size (mm) 32.0 (28.0–35.3) 28.0 (25.0–32.0) 30.3 (27.0–32.0) 35.8 (33.0–38.5) < 0.001 Ejection fraction (%) 62.5 ± 7.1 62.7 ± 5.8 64.3 ± 7.9 61.4 ± 7.6 0.199 LV diastolic parameters E wave (cm/s) 80.6 ± 19.7 86.2 ± 21.1 80.7 ± 21.7 76.5 ± 17.1 0.313 A wave (cm/s) 56.2 ± 15.1 52.9 ± 15.5 55.8 ± 12.7 58.5 ± 15.7 0.520 E/A ratio 1.4 (1.1–1.8) 1.7 (1.5–1.9) 1.4 (1.1–1.9) 1.3 (1.0–1.5) 0.002 E′ medial (cm/s) 9.5 (7.5–11.8) 10.7 (8.9–12.4) 9.3 (6.9–11.9) 8.7 (7.1-10.8) 0.028 E′ lateral (cm/s) 13.4 ± 3.3 14.8 ± 3.0 13.9 ± 3.1 12.2 ± 3.2 0.967 E/E′ lateral ratio 5.9 (5.0–7.0) 6.0 (5.0–7.0) 5.5 (4.9–7.0) 6.0 (5.1–7.0) 0.363 Data reported as means ± SD or median (IQR). IQR, interquartile range; LA, left atrial; PASP, pulmonary artery systolic pressure; RA, right atrial; RALS, right atrium longitudinal strain; RV, right ventricle; SD, standard deviation; TAPSE, tricuspid annular plane systolic excursion. #Independent t-test, p-value or Mann-Whitney test, p-value for non-normally distributed variables. *Statistical significance denoted by p-values < 0.05 Table 5. Multiple linear regression analysis for predictors of RA longitudinal strain Covariates Univariate regression Multivariate regression Multiple r, (p-value) Coefficient Standard error p-value Coefficient Standard error p-value Age (years) –0.06 0.10 0.558 0.40 (0.097) Male gender 3.17 2.13 0.141 –1.15 2.80 0.683 BMI –0.43 0.14 0.003 –0.72 0.29 0.013 BSA –6.61 6.30 0.297 16.20 10.28 0.118 RV S′ 0.81 0.51 0.114 0.47 0.56 0.410 RV base 0.0004 0.21 0.998 –0.10 0.22 0.644 RV E′ 0.49 0.33 0.149 0.98 0.73 0.186 RV A′ –0.11 0.36 0.764 –0.65 0.75 0.387 RV E′/A′ ratio 2.11 2.02 0.298 –5.77 5.76 0.319 RA volume/ BSA ratio –0.19 0.18 0.307 –0.20 0.19 0.307 BMI, body mass index; BSA, body surface area; RA, right atrial; RV, right ventricular.
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