Prognostic Value of Biatrial Mechanics in Hypertensive OSA Patients With Preserved Left Ventricular Function: A Speckle Tracking Echocardiography Study

PURPOSE: To characterize subclinical changes in left atrial (LA) and right atrial (RA) volumetric and strain parameters in hypertension (HTN) comorbid with obstructive sleep apnea (OSA) and to identify the prognostic value of atrial mechanics for adverse cardiovascular events in the left ventricular (LV) function-preserved HTN with OSA patients. METHODS: A total of 177 HTN patients with preserved LV function were enrolled and underwent speckle tracking echocardiography. They were divided into two groups: 104 with OSA (HTN-OSA group, mild: 36; moderate: 35; severe: 33) and 73 without OSA controls (HTN-non OSA group). During the 1-year follow-up, adverse cardiovascular events, including heart failure, atrial fibrillation, stroke and cardiovascular death, were recorded. RESULTS: HTN-OSA group demonstrated larger LA phasic volumes (p < 0.05), lower LA strain and volumetric function during reservoir and conduit period than HTN-non OSA group (p < 0.05). RA size increased, RA reservoir and contraction strain decreased in HTN-OSA versus non-OSA cases (p < 0.05). LA reservoir (LASr), pump strain and RA strain (RASr) decreased progressively with worsening OSA (p < 0.05). LASr ≤17.5% and RASr ≤36.5% were the optimal cutoffs for independently predicting adverse events. Furthermore, their combination further enhanced predictive performance (AUC = 0.883). CONCLUSION: Patients with HTN and OSA exhibit significant bi-atrial dilation and functional impairment compared to those with HTN alone. Moreover, in HTN-OSA patients with preserved LV function, LASr and RASr can detect cardiac functional alterations in different OSA stages and demonstrate robust predictive efficacy for adverse cardiovascular outcomes.