Obesity-induced left atrial dysfunction across age groups and cardiovascular conditions: a comprehensive review of diagnostic advances and clinical implications.

Obesity is a global health concern, affecting nearly half of the world's population and significantly increasing cardiovascular disease (CVD) risk. Among various cardiac impacts, left atrial (LA) dysfunction is a notable complication, especially given its association with atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), and diastolic dysfunction. This comprehensive review synthesizes findings from studies across age groups, from children to adults, evaluating obesity-induced alterations in LA structure and function. Using advanced diagnostic tools like speckle tracking echocardiography, we examine the impact of obesity on LA function, the potential reversibility of LA dysfunction, and implications for CVD progression. Studies show that elevated body mass index (BMI) correlates with LA enlargement, increased stiffness, and impaired reservoir and conduit strain, with specific changes observed across different cardiovascular conditions. In children, obesity-related insulin resistance is associated with increased LA stiffness, marking early indicators of metabolic and cardiac dysfunction. In adults, higher BMI independently reduces LA strain, compromising function and raising the likelihood of AF recurrence post-cardioversion or percutaneous interventions. Additionally, clinical manifestations such as exercise intolerance in obese HFpEF patients highlight LA stiffness as a predictor of poorer quality of life and reduced physical capacity. Importantly, weight loss interventions, including bariatric surgery, show promise in reversing LA dysfunction, suggesting a potential for reducing obesity-related cardiac risks. Our review underscores the value of incorporating LA strain metrics in routine cardiac assessments to identify subclinical changes early and guide preventive strategies in obese patients. Further research into therapeutic approaches targeting LA function is essential for reducing HFpEF incidence and improving cardiovascular outcomes in obesity.