LOWER PEAK ATRIAL LONGITUDINAL STRAIN VALUES ARE ASSOCIATED WITH OBESITY AND INSULIN RESISTANCE IN YOUNG PATIENTS WITH HYPERTENSION

Abstract

Objective: The aim of the study was to compare features of left atrium remodeling in young patients with arterial hypertension (HTN) according to metabolic health status Design and method: We enrolled 83 young subjects (23 [21; 25] years, 87% males) with HTN diagnosed with office blood pressure (BP) measurement and 24-hours ambulatory BP monitoring according to ESC guidelines criteria (2018). Patients with diabetes mellitus and cardiovascular diseases were not included. We performed routine clinical examination and lab tests and two-dimensional speckle-tracking echocardiography. Patients were divided in two subgroups according to their relation to median of left atrial reservoir strain (LASr) in general population (Nielsen AB. et al., 2021. doi:10.1093/ehjci/jeab201). We estimated and compared main clinical characteristics of obesity and lipid and carbohydrates metabolism including HOMA-IR and non-insulin-based metabolic scores for insulin resistance in derived subgroups with T-test. Results: Groups had similar age, sex and BP structure. Subjects with LASr less than 39,4% (n = 48) had higher body mass index (27,2±5,0 vs 24,1±3,7, p=0,0041), waist circumference (93,4±14,0 vs 83,0±10,7, p=0,001) and waist-to-hips ratio (0,90±0,07 vs 0,84±0,07, p=0,0007). Characteristics of lipid metabolism also varied in 2 groups: in lower LASr subgroup triglycerides concentration was higher (1,53±1,06 vs 0,81±0,28, p=0,0005) and high density lipoproteins (HDL) was lower (1,18±0,28 vs 1,55±0,53, p=0,0003) while there was no significant difference in total cholesterol and low density lipoproteins levels. Fasting glucose and HOMA-IR did not differ between the groups but significant differences were observed for non-insulin-based metabolic scores: in lower LASr group METS-IR, TG/HDL ratio and TyG index were higher (41,6±9,25 vs 33,0±6,4, p<0,0001; 3,38±2,94 vs 1,34±0,68, p=0,0004 and 8,55±0,60 vs 8,02±0,30, p<0,0001, respectively). In reverse stepwise regression model for the general group LASr were independently associated with the level of left ventricular ejection fraction, DBP24h, METS-IR index, while the relationship with the HDL-C, SBP24h, relative wall thickness, E/e’ were lost (METS-IR index and HDL-C were included after checking the collinearity). Conclusions: young patients with HTN with lower LASr have worse metabolic status estimated with non-insulin-based metabolic scores and obesity characteristics.