Left Atrial Strain as a Predictor of Early Diastolic Dysfunction in Hypertensive Patients – A Case-Control Study

Background: Hypertension is a major risk factor for the development of diastolic dysfunction, often preceding overt heart failure. Left atrial strain, derived from speckle-tracking echocardiography, is a sensitive measure of atrial mechanics and may serve as an early marker of diastolic impairment before conventional parameters become abnormal. This study Objective: aimed to evaluate and compare the components of left atrial strain as predictors of early diastolic dysfunction in hypertensive patients compared to non-hypertensive controls. A case-control study was conducted over six months, enrolling 50 parti Methods: cipants (25 hypertensive patients and 25 normotensive controls). Individuals with structural heart disease were excluded. All participants underwent a comprehensive echocardiographic examination using a Philips Affinity 50C machine. Two-dimensional speckle-tracking echocardiography was used to analyze the three phasic functions of the left atrium: reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct). Conventional Doppler parameters, including mitral inflow E/A ratio, were also assessed. The mean ages of the case Results: and control groups were comparable (57.6 ± 8.9 vs. 56.2 ± 7.4 years). The hypertensive group had significantly higher blood pressures. Conventional echocardiography revealed significant diastolic impairment in hypertensives, evidenced by a lower E/A ratio (0.98 ± 0.33 vs. 1.2 ± 0.43; p=0.048). All LA strain parameters were significantly impaired in the hypertensive group. Among these, LA conduit strain (LAScd) demonstrated the highest diagnostic accuracy for identifying early diastolic dysfunction, with an area under the curve (AUC) of 0.82, 80% sensitivity, and 76% specificity. Conclusion: Left atrial strain parameters are significantly impaired in hypertensive patients with early diastolic dysfunction. LA conduit strain emerged as the strongest predictor, suggesting its potential as a sensitive, early diagnostic tool for detecting subclinical diastolic impairment in hypertension, which could allow for earlier intervention.