Key result
Hypertension was associated with significantly higher total left atrial deformation (54.9% vs 45.5%, P<0.03) and impaired early filling, compensated by increased late filling and atrial contraction.
Why the study?
Does echocardiographic assessment of left atrial volume, strain/rate, and pulmonary flow reversal detect subclinical left atrial dysfunction in patients with mild-to-moderate hypertension compared to normotensive controls?
Cross-Sectional (n=108)
Does echocardiographic assessment of left atrial volume, strain/rate, and pulmonary flow reversal detect subclinical left atrial dysfunction in patients with mild-to-moderate hypertension compared to normotensive controls?
Absolute Event Rate: 54.9% vs 45.5%
p-value: p=< 0.03
Left atrial conduit volume expansion and Tissue Doppler-derived strain/strain rate imaging can effectively detect subclinical left atrial dysfunction in patients with mild-to-moderate hypertension.
May support LA strain imaging to detect subclinical dysfunction in mild hypertension; hypothesis-generating, needs prospective outcome validation.
BACKGROUND AND OBJECTIVES: Early changes in left atrial function in hypertension are difficult to assess quantitatively. Measuring atrial reversal flow into the pulmonary veins and regional left atrial deformation parameters assessed by Tissue Doppler-derived strain/rate (S/SR) imaging could provide quantitative assessment of left atrial deformation. We aimed to quantify changes in left atrial volume and deformation and pulmonary flow reversal (PVREVERS) in hypertension to detect subclinical left atrial dysfunction. DESIGN, SETTING AND PATIENTS: In 74 hypertensive and 34 age-matched normotensive patients (mean age 49 +/- 1.4 vs. 44.2 +/- 2.1 years) echo studies were performed, including measurements of LAV during reservoir, conduit and pump phases and standard indices reflecting left ventricular filling. S/SR was measured in the lateral left atrial wall. Total deformation (STOTAL) and the contribution to early (SE-index) and late (SA-index) filling were calculated. RESULTS: Hypertensive patients had significantly impaired diastolic function and increased left atrial volume during all phases. Only LAVCONDUIT significantly correlated with both ventricular hypertrophy and parameters of diastolic function. Velocity time integral of PVREVERS correlated with blood pressure and LAVCONDUIT. In hypertensive patients STOTAL was significantly higher (54.9 +/- 2.6 vs. 45.5 +/- 2.7%, P < 0.03) and SE-index was lower (P < 0.0001). This was compensated for by an increased SA-index (P < 0.0001) and SR during atrial contraction (-4.9 +/- 0.2 vs. -2.9 +/- 0.3 1/s, P < 0.0001). SA-index correlated significantly with blood pressure (R = 0.4; P < 0.0001) and PVREVERS (R = 0.3; P < 0.001). CONCLUSION: Changes in left atrial function due to hypertensive diastolic impairment are best reflected by LAVCONDUIT expansion. Hypertensive atrial dilatation is related to increase in PVREVERS. Left atrial S/SR offers a clinically valuable approach to detecting subclinical atrial dysfunction.
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Baltabaeva et al. (2009) conducted a cross-sectional in mild-to-moderate hypertension (n=108). Hypertension vs. Normotension was evaluated on Total left atrial deformation (STOTAL) (p=< 0.03). Hypertension was associated with significantly higher total left atrial deformation (54.9% vs 45.5%, P<0.03) and impaired early filling, compensated by increased late filling and atrial contraction.
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