Relationship of carotid arterial functional and structural changes to left atrial volume in untreated hypertension

Abstract

The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H).Aim The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters.Results Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P< 0.001), left ventricular mass index (LVMI; beta = 0.258, P< 0.001), E/e’ index (ratio of early mitral flow wave velocity – E to early diastolic mitral annular velocity – e’; beta = 0.266, P= 0.001), augmentation index (AI; beta = 0.143, P= 0.008) and body mass index (BMI; beta = 0.132, P= 0.017). No correlations between indexed LA volume and IMT were found.Conclusion There is a significant relationship between carotid arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.