The effect of urgent blood pressure lowering on left atrial mechanics in patients with hypertensive episode in emergency setting

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) dilatation and dysfunction are early manifestation of hypertension and represent end-organ damage. Hypertension is a well-known risk factor for atrial fibrillation. Long term effect of hypertension on the left ventricle and left atrium was well-studied before. In this study, we aimed to investigate the acute effect of urgent blood pressure reduction on the left atrial strain. Methods We prospectively enrolled 52 consecutive patients (age: 67.5 ± 8.9 years, 48.1% male) (Fig1) admitted to our emergency department with a hypertensive attack. All patients underwent baseline standard echocardiographic evaluation. 2D images from apical 4-chamber view were recorded for offline analysis. Reservoir (PALS) and contractile (PACS) left atrial strain measurements were performed by automated software using the onset of QRS as a reference point. Patients with systolic dysfunction, acute coronary syndrome and any rhythym other than sinus or with poor echogeneicity were excluded. All measurements were repeated after achieving target blood pressure reduction and analyzed. Results Urgent blood pressure reduction result in improvement in LA contractile strain (PACS) and LVEF and increase in heart rate and RV systolic function while LV dimensions, LA volumes and LAVI were decreased. There is a statistically significant negative moderate relationship between absolute change of DBP and absolute change of PALS (r=-0.423; p = 0.002). There is a statistically significant negative and weak correlation between the absolute change in SBP and the absolute change in PACS (r=-0.280; p = 0.044). Conclusion Assessment of LA strain by 2D speckle tracking echocardiography is easy to apply and noninasive method to quantify LA function even in emergency setting. This study showed that LA contractile strain (PACS) rather than LA reservoir strain (PALS) was significantly affected from LV end diastolic pressure. Abstract Figure 1 Abstract Figure 2