Assessment of Left Atrial Function in Patients With Arterial Hypertension, a Systematic Review and Meta-Analysis

Objective: Arterial hypertension (HTN) is a major risk factor for cardiovascular morbidity, leading to significant cardiac structural and functional changes. While left ventricular hypertrophy is a well-established consequence, the impact of HTN on left atrial (LA) function is increasingly recognized as a critical component of hypertensive heart disease and a key predictor of adverse outcomes. This systematic review and meta-analysis aimed to comprehensively evaluate LA mechanics in patients with arterial hypertension compared to healthy controls. Design and method: A systematic literature search was conducted in the PubMed/MEDLINE, Scopus, and Google Scholar databases through July 2025. Studies reporting on LA strain parameters via speckle-tracking echocardiography in hypertensive patients versus healthy controls were included. The final analysis comprised 24 studies, including 1802 hypertensive patients and 1161 controls. Results: This meta-analysis revealed that patients with arterial hypertension exhibit significant alterations in all phases of LA mechanics. Specifically, LA reservoir and conduit functions were significantly impaired, as demonstrated by reduced strain (LAS-R, LAS-E) and strain rate (LASR-S, LASR-E) values (all p<0.001). Conversely, LA contractile function was significantly increased in the hypertensive group (higher LAS-A and LASR-A values; p<0.001), suggesting a compensatory mechanism. Despite moderate-to-high heterogeneity in some analyses, no significant publication bias was detected. Conclusions: Left atrial strain analysis effectively identifies significant subclinical cardiac dysfunction in patients with arterial hypertension. This dysfunction presents as a distinct pattern of impaired LA reservoir/conduit function and a compensatory increase in contractile function, which may precede overt structural changes. These advanced echocardiographic parameters represent valuable tools for early diagnosis, monitoring therapeutic response, and risk-stratifying patients for complications like atrial fibrillation.