Key result
Higher mean arterial pressure independently links to increased left atrial volume index in lower-LVMI patients.
Cross-Sectional (n=205)
No
Effect estimate: β = 0.35
p-value: p=0.004
In individuals with lower left ventricular mass, left atrial volume index is driven by the steady component of blood pressure (mean arterial pressure) rather than the pulsatile component, serving as an early marker of hypertensive heart disease.
May flag early atrial effects of steady pressure load independent of LV mass; hypothesis-generating for prospective validation.
Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females-66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e') (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.
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Rojek et al. (2017) conducted a cross-sectional in Left atrial enlargement (n=205). Mean arterial pressure (steady blood pressure component) vs. Pulse pressure (pulsatile blood pressure component) was evaluated on Prediction of left atrial volume index (LAVI) by office mean arterial pressure in patients with left ventricular mass index below the median (β = 0.35, p=0.004). In individuals with lower left ventricular mass index, left atrial volume index was independently predicted by mean arterial pressure (β = 0.35), but not by pulse pressure.
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