Left atrial strain in patients with arterial hypertension

Background: Arterial hypertension (HTN) causes left ventricular (LV) cavity dysfunction even if ejection function (EF) remains preserved. Recent studies have shown that diastolic dysfunction and left atrial (LA) dilatation are also associated with myocardial dysfunction. The aim of the present study was to explore the nature of LA longitudinal function disturbances in hypertensive patients with normal LV and LA structure and conventional function parameters. Methods: Peak atrial longitudinal strain (PALS) was evaluated in 78 patients with systemic HTN and preserved EF (≥ 55%) divided in 41 patients with diastolic dysfunction but no hypertrophy (group HTNdd), and 37 patients with no diastolic dysfunction or hypertrophy (group eHTN). Results were compared with those from 38 age and gender-matched healthy controls. Results: Indexed LA area and indexed LA volume were within the normal range and not different between the two patient groups and controls. eHTN group had reduced global PALS (p < 0.001) and four-and two-chamber average PALS (p < 0.001 for both). Similar abnormalities were seen in HTNdd group but to a worse degree (P < 0.01 for both). LV EF was not different between the eHTN and HTNdd groups compared to controls. LV E/e’ ratio was the strongest predictor of reduced global PALS in both eHTN and HTNdd groups. Conclusion: Asymptomatic untreated HTN patients with preserved LVEF and normal diastolic function have compromised LA strain despite normal cavity size, consistent with preclinical LA myocardial dysfunction.