Abstract
BackgroundTo evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance.MethodsLA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%).ResultsCompared with controls, PALSres, PALScond and PALSRcond were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALSpump, PALSRpump and TpSpump-SD% between them (all P > 0.05). PALSpump, PALSRpump and PALSRres were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSRpump was further depressed in patients with both hypertension and PAF (P = 0.029). PALSRcond ≤ 1.475 s− 1 combined with TpSpump-SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALSpump ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m2 was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF.ConclusionsThe impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.
Highlights
Hypertension and atrial fibrillation (AF) are both associated with left atrial (LA) structural and functional abnormalities
Previous work has demonstrated the relationship between hypertension and LA dysfunction [2], and AF episodes always result in loss of LA pump function, but what are the differences of the impact on LA phasic functions between the coexistence of both conditions and isolated hypertension or AF was not well elucidated
Indexed left ventricular (LV) mass (LVMI), LA volume index (LAVI) and E/e’ ratio were increased in hypertensive patients than normotensive patients, but no significant differences was found between hypertensive patients with paroxysmal atrial fibrillation (PAF) and those without PAF
Summary
Hypertension and atrial fibrillation (AF) are both associated with left atrial (LA) structural and functional abnormalities. LA enlargement in the patients with hypertension or AF is a common clinical phenomenon. Previous work has demonstrated the relationship between hypertension and LA dysfunction [2], and AF episodes always result in loss of LA pump function, but what are the differences of the impact on LA phasic functions between the coexistence of both conditions and isolated hypertension or AF was not well elucidated. Strain and strain rate (SR) reflect different aspects of myocardial deformation. The strain, which equals the time integral of the SR, is deformation of an object relative to its original length. To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance
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