Research ArticleEarly predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension
Introduction
Recent studies have provided increasing evidence that hypertension may be a potential causal, independent risk factor for heart failure with preserved ejection fraction,1, 2 although the pathophysiology underlying the development of this syndrome remains incompletely defined. Left ventricular (LV) diastolic filling abnormalities are common in hypertension and can be seen even in the absence of LV remodeling, particularly concentric hypertrophy.3 On the other hand, because left atrium (LA) is directly exposed to LV pressures during ventricular diastole, LA size has been linked to HbA1c in the assessment of LV filling pressure.4 Therefore, LA structural remodeling is a more stable indicator, reflecting the duration and severity of diastolic LV dysfunction.5 An accurate examination of alterations in not only LA structure but also function is an important and necessary step forward to early diagnosis of abnormal LA-LV coupling in cardiovascular disease. Recently, the development of two-dimensional speckle-tracking echocardiography (2DSTE) has facilitated the early detection of LA and LV dysfunction in the absence of LA enlargement6 or impaired LV relaxation,7, 8 and in the presence of preserved LV ejection fraction,9, 10 in patients with cardiovascular risk factors, including hypertension. The present study was designed to evaluate the negative effects of hypertension on changes in LA structure and function related to LV dysfunction due to chronic pressure overload, and to clarify the early predictors of both the LA alterations using conventional and 2DSTE.
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Study Population
Two hundred and eighty-five patients from routine health checkups and outpatient facilities at Higashi Tokushima Medical Center between 2009 and 2012 were recruited to participate in the present study. The study protocol was approved by the ethics committee of the institution involved. Interview, electrocardiogram, physical examination, and conventional echocardiography were performed in all patients. As a result, 87 of the 285 patients were excluded for the following reasons: history of heart
Clinical, M-Mode, Two-Dimensional, and Pulsed Doppler Echocardiographic Variables
There were no differences in age and LV ejection fraction between the control and hypertensive groups (Table 1). The BMI, SBP, and DBP were greater in the hypertensive group than in the control group. Also, the end-diastolic LV diameter, end-diastolic ventricular septal and LV posterior wall thicknesses, relative LV wall thickness, and LV mass index were greater in the hypertensive group than in the control group.
The peak atrial systolic velocity of transmitral flow (A) and the deceleration
Discussion
In the present study, we investigated the relationships between LA functional and structural changes and LV dysfunction related to chronic pressure overload in asymptomatic patients with hypertension. Based on the multivariate analyses, it was clarified that 1) BMI and peak systolic LV radial strain contribute to the prediction of peak LA strain during ventricular systole (S-LAs), and 2) LV mass index, peak A velocity of the transmitral flow, and E/e’ contribute to the prediction of LAVI. To
Conclusion
LV diastolic and systolic dysfunction was a potent independent predictor of LA structural and functional changes, respectively, in asymptomatic patients with hypertension. The use of 2DSTE gives new insights into alterations in LA structure and function related to LV dysfunction, underlining the key role of LA-LV coupling.
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Left Atrial Strain Correlates with Elevated Filling Pressures in Pediatric Heart Transplantation Recipients
2020, Journal of the American Society of EchocardiographyCitation Excerpt :In adult studies, Ɛres has superior diagnostic accuracy for elevated PCWP or left ventricular end-diastolic pressure14,15 and in correlating with heart failure symptoms.16-19 In addition, Ɛres has been shown to correlate with B-type natriuretic peptide levels20 and is likely the most correlative with LV filling pressure because the left ventricular end-diastolic pressure is the afterload on the LA, leading to mechanical stress and reduced atrial compliance during the reservoir phase.21-23 The Ɛcon and Ɛac only relate to the LA's ability to empty, rather than the chamber's compliance, which may explain their inability to discriminate an elevated PCWP relative to Ɛres.
Interaction effect of hypertension and obesity on left atrial phasic function: a three-dimensional echocardiography study
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2023, Frontiers in Cardiovascular MedicineLeft atrial phasic function remodeling during its enlargement: a two-dimensional speckle-tracking echocardiography study
2022, BMC Cardiovascular Disorders
Conflict of interest: None declared (all authors).