Key result
In subjects with normal left atrial size, hypertension was associated with significantly reduced total atrial strain (21.35% vs 23.01%, p=0.008), indicating that left atrial functional remodeling occurs before anatomical enlargement.
Why the study?
The exact relationship between LA size and phasic function, and whether LA dysfunction occurs prior to LA enlargement, have not been fully studied.
Does left atrial phasic function remodeling occur before left atrial enlargement in patients at high cardiovascular risk?
Cross-Sectional (n=715)
Does left atrial phasic function remodeling occur before left atrial enlargement in patients at high cardiovascular risk?
Absolute Event Rate: 21.35% vs 23.01%
p-value: p=0.008
Left atrial phasic function remodeling, particularly impaired reservoir and conduit function, occurs before left atrial enlargement in high-risk patients, especially those with hypertension.
Impaired LA phasic function in normal-sized LA with hypertension supports early remodeling; hypothesis-generating and needs prospective validation.
Background Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atria thought to represent a “dysfunctioning” atrium, since there is no accepted ‘gold’ standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physic deformation. Materials and methods A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain =Sa+Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between sub-groups in normal LA size with and without hypertension (HT). Results With LAE (from normal size, mild, moderate to severe LAE), the Stot(21.74±5.97,20.75±4.99,20.49±5.27,17.75±4.71, respectively, ANOVA p=0.003) and Sa (11.84±3.92,11.00±3.29,10.11±2.57,8.55±2.88, respectively, ANOVA p<0.001) reduced while Se had no change. In normal sized LA subgroups, Stot (21.35±5.91 vs 23.01±6.02, p=0.008) and Se (9.51±4.41 vs 11.17±4.89, p<0.001) reduced in subjects with HT comparing with those without. Conclusion LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.
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Chen et al. (2021) conducted a cross-sectional in High cardiovascular disease risk (n=715). Hypertension and left atrial enlargement vs. Normotensive subjects and normal left atrial size was evaluated on Total atrial strain (Stot) in subjects with normal left atrial size (Hypertension vs Non-Hypertension) (p=0.008). In subjects with normal left atrial size, hypertension was associated with significantly reduced total atrial strain (21.35% vs 23.01%, p=0.008), indicating that left atrial functional remodeling occurs before anatomical enlargement.
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