Left atrial global longitudinal strain as an early preventive marker in arterial hypertension

Abstract Background/Introduction Arterial hypertension contributes to progressive mechanical and structural impairment of the left atrium. Early detection of subclinical atrial dysfunction may provide a preventive window to reduce the risk of atrial fibrillation and poor blood pressure control. Left atrial reservoir strain (LA-GLS) is a sensitive echocardiographic marker capable of identifying early functional alterations before chamber enlargement becomes evident. Purpose To evaluate whether LA-GLS–guided preventive management improves atrial function and blood pressure control in individuals with arterial hypertension. Methods A prospective study enrolled adults aged 40–65 years with untreated or clinic-based insufficiently controlled hypertension (≥140/90 mmHg). Participants were allocated to either standard hypertension management (n=60) or standard management plus LA-GLS–guided evaluation and targeted interventions (n=60). Comprehensive echocardiography, including LA reservoir strain, left atrial volume, and diastolic indices, was performed at baseline and at 12 months. Clinical outcomes included blood pressure control and new-onset atrial fibrillation. Results Baseline LA-GLS was similar between groups (standard: −19.0±2.5%; LA-GLS–guided: −18.8±2.4%). After 12 months, LA-GLS changed minimally in the standard group (−19.5±2.6%; +0.5%), whereas it improved in the guided group (−21.0±2.1%; +2.2%; p0.01). Left atrial volume decreased only in the guided group (−10 mL; p0.05). Blood pressure control was achieved in 65% of the standard group and 80% of the guided group (p=0.04). New-onset atrial fibrillation occurred in 7 participants in the standard group and in 2 participants in the guided group (p=0.06; trend). ROC analysis identified LA-GLS ≤−18.5% as a predictor of early atrial mechanical impairment (sensitivity 0.85). LA-GLS remained an independent predictor after adjustment (HR 2.3; p=0.02). Conclusion(s) LA-GLS enables early detection of atrial dysfunction in individuals with arterial hypertension and enhances preventive management. Incorporation of LA-GLS into follow-up improved atrial function and blood pressure control and may contribute to a lower incidence of atrial fibrillation. These findings support the integration of LA-GLS into preventive strategies and justify larger confirmatory studies.Receiver operating characteristic (ROC)For image description, please refer to the figure legend and surrounding text.