The Relationship Between Cardio-Ankle Vascular Index and Left Atrial Phasic Function in Hypertensive Patients With Preserved Ejection Fraction.

Tsuyoshi Tabata,Kazuhiro Shimizu,Yukihiro Morinaga,Ruiko Yoshida,Masahiro Iwakawa,Nobuo Takada,Hajime Kiyokawa,Naoaki Tanji

doi:10.3389/fmedt.2021.724089

Abstract

Background: To investigate the relationship between arterial stiffness, reflected by cardio-ankle vascular index (CAVI) value, and left atrial (LA) phasic function in hypertensive patients with preserved left ventricular ejection fraction (LVEF).Methods: We retrospectively studied 165 consecutive patients (mean age, 66.5 ± 11.7 years) diagnosed with hypertension with preserved LVEF who had undergone CAVI measurement and echocardiography on the same day. The latter included speckle-tracking echocardiography to assess LA phasic function (reservoir, conduit, and pump strain) and left ventricular global longitudinal strain (LVGLS).Results: The results of univariate analysis showed CAVI value to be correlated with LA reservoir strain and LA conduit strain (r = −0.387 and −0.448, respectively; both P < 0.0001). The results of multiple linear regression analysis showed CAVI value to be independently related to age (β = 0.241, P = 0.002) and LA conduit strain (β = −0.386, P = 0.021) but not LV mass index, LA volume index, or LV systolic function (including LVGLS).Conclusion: In hypertensive patients with preserved LVEF, increased CAVI value appears to be independently associated with impaired LA phasic function (particularly LA conduit function) before LA and LV remodeling. CAVI determination to assess arterial stiffness may be useful in the early detection of interactions between cardiovascular abnormalities in hypertensive patients.

Highlights

Arterial stiffness increases the risk of cardiovascular morbidity and mortality in patients with hypertension
In the early stages of hypertension, left atrial (LA) pump function may increase to compensate for impairment of left ventricular (LV) diastolic function; it has been shown to be higher in patients with mild hypertension compared with control subjects, whereas reservoir and conduit function were unchanged [16, 17]
The results of the present study are the first to show that increased arterial stiffness is related to impaired LA reservoir and conduit function even before the development of LA dilatation and LV hypertrophy. They show that LV filling pressure is not increased in hypertensive patients with preserved left ventricular ejection fraction (LVEF). These findings suggest that increased arterial stiffness may detect an overload in the early stages of interactions between cardiovascular abnormalities in hypertensive patients

Summary

Introduction

Arterial stiffness increases the risk of cardiovascular morbidity and mortality in patients with hypertension. It impairs blood flow from left atrium to left ventricle, increasing left atrial (LA) pressure and preload. As the left atrium tries to compensate for the resulting physiological effects, it becomes dilated and functionally impaired. These changes in LA size and function progress in proportion to the degree of left ventricular (LV) dysfunction [1]. To investigate the relationship between arterial stiffness, reflected by cardio-ankle vascular index (CAVI) value, and left atrial (LA) phasic function in hypertensive patients with preserved left ventricular ejection fraction (LVEF)

Methods

Results

Discussion

Conclusion