LEFT AND RIGHT ATRIAL FUNCTION AND DIMENSION - MARKERS OF PAROXYSMAL ATRIAL FIBRILLATION IN HYPERTENSIVES

Abstract

Objective: Introduction: Hypertension increases the risk for atrial fibrillation and is the most common underlying risk factor for the development of atrial fibrillation (1). Discovering predictors for the onset of atrial fibrillation in hypertensives may have prognostic value. Objective: We evaluated left atrium (LA) and right atrium (RA) dimension and function in our attempt to find an echocardiographic marker of paroxysmal atrial fibrillation in hypertensive patients without other significant heart disease.Design and method: Methods: We prospectively enrolled three groups of patients: 21 heathy patients (Group 1); 42 hypertensive patients without paroxysmal atrial fibrillation (Group 2) and 22 hypertensive patients with paroxysmal atrial fibrillation (Group 3) Secondary causes of HTN and other coexistent severe pathology were excluded. LA and RA diameters and volumes were measured by echocardiography, using modified Simpson biplane method. Peak longitudinal strain of LA and RA walls were analyzed using 2D speckle-tracking echocardiography. We also measured the LV mass using the M-mode method, but also area-length method. Results: LA and RA diameters, as well as all the volumes were significantly greater in hypertensive groups compared to controls (p < 0.001). There was found a significant difference between peak LA and RA longitudinal strain parameters in the three groups, with the lowest values in Group 3 (p < 0.001). There was also found a significant difference of LV mass between the three groups (p < 0.001); the highest values of the LV mass are found in the patients with hypertension and atrial fibrillation (p < 0.001, R = 0.453) A strong negative correlation between LV linear mass/BSA and LA PALS (peak atrial longitudinal strain) was determined (p = 0.003, R = -0.645) which means that patients with LV linear mass/BSA at high values have also low values of LA PALS in group with atrial fibrillation compared with the other 2 groups. Conclusions: In our study hypertension was associated with structural and functional remodeling of both LA and RA. So, speckle tracking methods and volumes applied for both atria can be successfully used in identifying hypertensive patients with LA and RA dysfunction at high risk to develop atrial fibrillation.