Echocardiographic left atrial remodelling in the early phase of high blood pressure and its correlation with microalbuminuria: A case control study in sub-Saharan Africans

Abstract

Left atrial remodelling (LAR) is a common finding in patients with chronic hypertension and increases the risk of adverse cardiovascular events. However, early changes in the left atrial size and association microalbuminuria are poorly elucidated. To assess early left atrial structural remodelling in hypertensive patients and determine its correlation with microalbuminuria. Fifty-two patients diagnosed with hypertension for less than a year were matched for age sex to forty healthy controls. Patients with pre-existing, cardiovascular disease, kidney disease and diabetes were excluded. The left atrial endocardial border was traced to get atrial length, transverse diameter, surface area and volume while the anteroposterior diameter was obtained on the parasternal long axis by M-Mode echocardiography. Early morning urine was analysed for microalbuminuria. The hypertensive patients and controls were comparable for age and sex, but had significantly higher body mass indices, Left ventricular mass (LVM) and an altered diastolic function. Hypertensive patients had significant increase in the left atrial longitudinal diameter (50.0 mm versus 47.4 mm, P = 0.045 mm), surface area (17.9 cm 2 versus 15.5 cm 2 , P = 0.003) and volume (52.4 ml versus 43.8 ml, P = 0.002). Fourteen hypertensive patients (26.9%) had left atrial enlargement compared to 1 (2.5%) in the control group ( P = 0.001). Diastolic dysfunction ( P = 0.008) was the only independent predictor of LA size and LAE. There was a no correlation between microalbumin and left atrial size. Changes in the left atrial size in the early phase of hypertension characterised increase left atrial length, surface area and volume. Left atrial remodelling in hypertension is an evidence of the chronicity of diastolic dysfunction. Microalbuminuria does not predict left atrial remodelling.