Introduction
Methods
Study Population
Echocardiographic acquisition
Two-dimensional Speckle Tracking Analyses
Inter- and intra-observer variability
Statistical analysis
Results
General Characteristics
Variable | Controls (n = 28) | Isolated HTN group (n = 25) | Lone AF group (n = 24) | HTN and PAF group (n = 28) | P |
---|---|---|---|---|---|
Age, years | 56.7 ± 9.3 | 58.3 ± 8.9 | 53.8 ± 6.7 | 60.9 ± 6.6 | 0.386 |
Female gender, n (%) | 13 (46%) | 14 (56%) | 13 (54%) | 8 (29%) | 0.166 |
Height, cm | 166.8 ± 8.1 | 163.8 ± 6.7 | 170.0 ± 10.1 | 165.8 ± 7.4 | 0.061 |
Weight, kg | 62.6 ± 9.6 | 62.2 ± 10.7 | 65.8 ± 10.0 | 65.7 ± 9.4 | 0.403 |
Body mass index, kg/m2 | 22.29 ± 2.53 | 23.06 ± 2.79 | 22.26 ± 2.36 | 23.83 ± 2.42 | 0.079 |
Body surface area, m2 | 1.70 ± 0.16 | 1.67 ± 0.17 | 1.77 ± 0.17 | 1.73 ± 0.15 | 0.180 |
Heart rate, beats/min | 73.0 ± 7.7 | 70.5 ± 7.3 | 67.4 ± 11.5 | 68.5 ± 6.5 | 0.108 |
SBP, mm Hg | 114.1 ± 6.9 | 159.0 ± 13.5* | 113.9 ± 6.9 | 162.1 ± 8.8* | 0.000 |
DBP, mm Hg | 83.2 ± 3.7 | 100.4 ± 5.6* | 80.6 ± 4.7 | 99.6 ± 7.3* | 0.000 |
History of HTN, years | – | 8.0 ± 4.6 | – | 11.9 ± 4.5# | 0.003 |
History of AF, years | – | – | 4.5 ± 3.9 | 5.4 ± 4.5 | 0.468 |
Current smoker, n (%) | 5 (18%) | 10 (36%) | – | 9 (32%) | 0.198 |
Current drinker, n (%) | 4 (7%) | 5 (28%) | – | 8 (46%) | 0.418 |
Medications, n (%) | |||||
ACEI or ARB | – | 13 (52%) | – | 16 (57%) | 0.707 |
β-blockers | – | 7 (28%) | – | 6 (21%) | 0.579 |
Calcium antagonists | – | 6 (24%) | – | 6 (21%) | 0.823 |
Antiplatelet | – | – | 8 (33%) | 11 (39%) | 0.657 |
Anticoagulant agent | – | – | 11 (46%) | 15 (54%) | 0.578 |
Antiarrhythmic drug | – | – | 12 (50%) | 17 (61%) | 0.438 |
Diuretics | – | 5 (20%) | 3 (13%) | 8 (46%) | 0.360 |
Statins | – | 8 (32%) | 4 (17%) | 11 (39%) | 0198 |
Mild mitral regurgitation, n (%) | – | 4 (16%) | 7 (29%) | 10 (36%) | 0.266 |
Mild aortic regurgitation, n (%) | – | 8 (32%) | 3 (13%) | 11 (39%) | 0.093 |
LVEF, % | 64.16 ± 2.79 | 63.65 ± 4.12 | 63.54 ± 4.13 | 63.86 ± 3.29 | 0.936 |
LVMI, g/m2 | 81.44 ± 7.26 | 108.52 ± 12.26* | 77.41 ± 6.87 | 109.60 ± 19.21* | 0.000 |
E/e’ ratio | 8.24 ± 1.88 | 10.51 ± 2.85* | 9.74 ± 2.76 | 10.96 ± 8.05* | 0.007 |
LAVI, mL/m2 | 25.73 ± 5.66 | 31.93 ± 8.62* | 27.60 ± 8.47 | 33.16 ± 10.08* | 0.007 |
LA Phasic Mechanical Functions
Variable | Controls (n = 28) | Isolated HTN group (n = 25) | Lone AF group (n = 24) | HTN with PAF group (n = 28) | P |
---|---|---|---|---|---|
LA strain indexes (%) | |||||
PALSpump | −17.13 ± 2.94 | −16.65 ± 2.90 | −13.73 ± 5.06*# | −11.62 ± 4.19*# | 0.000 |
PALSres | 36.10 ± 4.90 | 29.95 ± 5.56* | 29.45 ± 7.53* | 26.49 ± 6.64* | 0.000 |
PALScond | −18.96 ± 4.56 | −13.30 ± 4.81* | − 15.73 ± 5.26* | −14.87 ± 5.30* | 0.001 |
LA strain rate indexes (s−1) | |||||
PALSRpump | −2.49 ± 0.45 | −2.30 ± 0.57 | −1.88 ± 0.78* | −1.54 ± 0.62*#& | 0.000 |
PALSRres | 1.71 ± 0.30 | 1.57 ± 0.71 | 1.43 ± 0.34* | 1.23 ± 0.31*# | 0.001 |
PALSRcond | −1.80 ± 0.95 | −1.07 ± 0.41* | − 1.18 ± 0.35* | −1.10 ± 0.33* | 0.000 |
LA strain ratio and strain rate ratio indexes | |||||
PALSpump/PALSres | 0.48 ± 0.08 | 0.57 ± 0.11* | 0.46 ± 0.13# | 0.44 ± 0.13# | 0.001 |
PALScond/PALSres | 0.52 ± 0.08 | 0.43 ± 0.11* | 0.54 ± 0.13# | 0.56 ± 0.13# | 0.001 |
PALSpump/PALScond | 0.96 ± 0.31 | 1.48 ± 0.77* | 0.97 ± 0.47# | 0.90 ± 0.53# | 0.001 |
PALSRpump/PALSRcond | 1.55 ± 0.50 | 2.39 ± 0.93* | 1.79 ± 0.81# | 1.52 ± 0.90# | 0.000 |
LA synchrony indexes (%) | |||||
TpSpump-SD% | 2.80 ± 0.89 | 3.48 ± 1.21 | 3.75 ± 1.33* | 4.19 ± 1.47* | 0.001 |
TpSres-SD% | 5.84 ± 0.95 | 6.68 ± 1.76 | 7.22 ± 2.39* | 6.70 ± 2.03 | 0.071 |
TpSRpump-SD% | 2.69 ± 0.72 | 2.72 ± 0.72 | 2.96 ± 1.19 | 3.06 ± 1.12 | 0.386 |
TpSRres-SD% | 5.67 ± 2.12 | 5.61 ± 1.54 | 5.67 ± 1.82 | 6.29 ± 1.93 | 0.463 |
TpSRcond-SD% | 4.13 ± 1.40 | 4.67 ± 1.24 | 4.47 ± 1.09 | 4.49 ± 1.33 | 0.480 |
LA Strain and SR
LA Dyssynchrony
Analyses to identify differentiators in the heterogeneous population
Variable | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | P | OR | 95% CI | P | |
Age | 0.967 | 0.911–1.027 | 0.273 | |||
Female gender | 0.635 | 0.212–1.902 | 0.417 | |||
Heart rate | 0.941 | 0.884–1.001 | 0.056 | |||
LVEF | 0.980 | 0.837–1.147 | 0.800 | |||
LVMI | 0.921 | 0.847–1.001 | 0.053 | |||
E/e’ ratio | 1.386 | 1.048–1.832 | 0.022 | 1.372 | 0.960–1.960 | 0.083 |
LAVI | 1.016 | 0.926–1.114 | 0.743 | |||
PALSpump | 0.801 | 0.672–0.954 | 0.013 | 0.701 | 0.418–1.173 | 0.176 |
PALSres | 0.836 | 0.740–0.945 | 0.004 | 1.189 | 0.838–1.689 | 0.333 |
PALScond | 0.870 | 0.764–0.990 | 0.034 | 1.160 | 0.808–1.665 | 0.422 |
PALSRpump | 0.267 | 0.090–0.786 | 0.017 | 2.718 | 0.160–46.264 | 0.489 |
PALSRres | 0.052 | 0.005–0.505 | 0.011 | 2.957 | 0.032–276.719 | 0.640 |
PALSRcond | 0.028 | 0.003–0.250 | 0.001 | 0.006 | 0.000–0.581 | 0.028 |
TpSpump-SD% | 2.310 | 1.203–4.436 | 0.012 | 2.294 | 1.228–4.285 | 0.009 |
TpSres-SD% | 1.653 | 1.082–2.524 | 0.020 | 1.345 | 0.927–1.954 | 0.119 |
TpSRpump-SD% | 1.368 | 0.723–2.589 | 0.335 | |||
TpSRres-SD% | 1.000 | 0.745–1.340 | 0.997 | |||
TpSRcond-SD% | 1.241 | 0.784–1.964 | 0.357 |
Variable | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | P | OR | 95% CI | P | |
Age | 1.035 | 0.965–1.109 | 0.335 | |||
Female gender | 2.43 | 0.829–7.120 | 0.106 | |||
Heart rate | 0.968 | 0.891–1.051 | 0.436 | |||
History of HTN | 1.209 | 0.997–1.396 | 0.056 | |||
SBP | 1.026 | 0.976–1.079 | 0.311 | |||
DBP | 0.982 | 0.903–1.068 | 0.670 | |||
LVEF | 0.988 | 0.847–1.153 | 0.882 | |||
LVMI | 1.011 | 0.958–1.066 | 0.697 | |||
E/e’ ratio | 1.047 | 0.873–1.255 | 0.621 | |||
LAVI | 1.014 | 0.954–1.079 | 0.649 | |||
PALSpump | 0.702 | 0.583–0.846 | 0.000 | 0.620 | 0.457–0.843 | 0.002 |
PALSres | 0.913 | 0.835–0.998 | 0.046 | 1.179 | 0.942–1.475 | 0.150 |
PALScond | 1.065 | 0.956–1.187 | 0.252 | |||
PALSRpump | 0.101 | 0.030–0.343 | 0.000 | 0.146 | 0.005–4.103 | 0.258 |
PALSRres | 0.090 | 0.012–0.656 | 0.018 | 0.365 | 0.007–20.313 | 0.623 |
PALSRcond | 1.221 | 0.282–5.282 | 0.790 | |||
TpSpump-SD% | 1.485 | 0.975–2.262 | 0.065 | |||
TpSres-SD% | 1.008 | 0.763–1.331 | 0.957 | |||
TpSRpump-SD% | 1.493 | 0.813–2.742 | 0.196 | |||
TpSRres-SD% | 1.252 | 0.916–1.711 | 0.159 | |||
TpSRcond-SD% | 0.897 | 0.594–1.356 | 0.607 |
Variable | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | P | OR | 95% CI | P | |
Age | 1.066 | 0.992–1.145 | 0.081 | |||
Female gender | 2.955 | 0.938–9.309 | 0.064 | |||
Heart rate | 1.014 | 0.953–1.077 | 0.665 | |||
LVEF | 1.024 | 0.881–1.190 | 0.755 | |||
History of AF | 1.052 | 0.919–1.205 | 0.462 | |||
E/e’ ratio | 1.135 | 0.944–1.363 | 0.177 | |||
LAVI | 1.088 | 1.015–1.166 | 0.017 | 1.077 | 1.021–1.136 | 0.006 |
PALSpump | 0.901 | 0.792–1.025 | 0.114 | |||
PALSres | 0.940 | 0.865–1.021 | 0.143 | |||
PALScond | 0.969 | 0.870–1.079 | 0.562 | |||
PALSRpump | 0.343 | 0.141–0.838 | 0.019 | 0.433 | 0.114–1.648 | 0.220 |
PALSRres | 0.150 | 0.024–0.937 | 0.042 | 0.812 | 0.091–7.254 | 0.852 |
PALSRcond | 0.474 | 0.085–2.644 | 0.394 | |||
TpSpump-SD% | 1.254 | 0.830–1.894 | 0.282 | |||
TpSres-SD% | 0.894 | 0.687–1.162 | 0.401 | |||
TpSRpump-SD% | 1.368 | 0.723–2.589 | 0.335 | |||
TpSRres-SD% | 1.000 | 0.745–1.340 | 0.997 | |||
TpSRcond-SD% | 1.241 | 0.784–1.964 | 0.357 |
Discussion
STE can provide excellent visualization of the phasic LA mechanical function. In this study, we evaluated LA phasic functions using STE in patients with hypertension, PAF, or both and explored the differences of impact on phasic LA mechanical functions between patients with both hypertension and PAF, and those with isolated hypertension or lone AF, and then further to study the clinical implications of disturbed LA phasic functions in the heterogeneous population associated with hypertension or lone AF. Our findings suggest that (1) in early stage of hypertension, conduit function is the most severely impaired, followed by reservoir function, while booster pump function is still preserved and contribution proportion of pump phase shows a compensatory increase. (2) With the occurrence of AF causing decompensation in hypertensive patients, LA booster pump function is impaired and reservoir function is further depressed. (3) LA reservoir, conduit and booster pump function are impaired in lone AF patients even with normal LA size. The magnitude of this impairment in booster pump and reservoir phase is further increased in subjects with coexisting hypertension and PAF in comparison with those with isolated hypertension or lone AF. (4) Decreased conduit SR combined with advanced contractile dyssynchrony could further improve the accuracy of differentiating lone AF from healthy subjects, while in hypertensive patients with enlarged LA, decreased contractile strain was proved to have the independent capability of differential diagnosis for the occurrence of AF or not. As far as the differences of LA remodeling between two types of AF, LAVI was an independent characteristic for reflecting it.