Impaired LA and LV relaxation in the longitudinal direction are early signs of abnormal LA-LV coupling related to arterial stiffness in preclinical patients with cardiovascular risk factors. 2DSTE enables the quantitative assessment of the LA and LV function, and can be considered a sensitive tool for detecting the abnormal LA-LV-arterial coupling.

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In patients with hypertension, an elevation in SBP leads to increased LA stiffness during ventricular systole and LV diastolic stiffness, in association with continued and further advanced LV diastolic dysfunction. 2DSTE is considered a sensitive tool for detecting abnormal LA-LV coupling related to an increased LV pressure overload.

1490OISHI Y et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp tion, and its relationship with changes in arterial stiffness, namely, LA-LV-arterial coupling. 9 The new angle-independent 2-dimensional speckle-tracking echocardiography (2DSTE) permits the evaluation of not only LA and LV myocardial deformation 9-12 but also aortic and carotid arterial circumferential deformation. 13, 14 The main aim of the present study was to detect earlier the possible effect of cardiovascular risk factors on LA and LV function related to abdominal aortic (AAO) stiffness using 2DSTE in asymptomatic patients, which is likely to prevent the development to HFPEF via the early intervention of statins or angiotensin II receptor blockers with arterio-and cardioprotective effects.reviously, heart failure with preserved ejection fraction (HFPEF) has been attributed to left ventricular (LV) diastolic dysfunction and myocardial stiffness, resulting in elevated LV end-diastolic pressure, 1 particularly in patients with hypertrophic cardiomyopathy. 2 In contrast, cardiovascular risk factors, such as hypertension, diabetes, dyslipidemia, and obesity, have recently been demonstrated to be associated with HFPEF. 3,4 Also, arterial stiffness is widely accepted as a strong predictor of HF symptoms in patients with HFPEF, 5,6 and this increase is accelerated with aging, 7 and in the presence of cardiovascular risk factors. 8 This suggests that HFPEF develops as a progression in asymptomatic patients with cardiovascular risk factors. Previous studies, however, were unable to draw a clear conclusion on the effect of cardiovascular risk factors on left atrial (LA) and LV func- Background: The aim of the present study was to detect earlier the negative effect of cardiovascular risk (CVR) factors on left atrial (LA) and left ventricular (LV) function related to abdominal aortic (AAO) stiffness using 2-dimensional speckle-tracking echocardiography (2DSTE) in asymptomatic patients.

Left atrial (LA) structural and functional abnormalities are vital steps on the pathway toward heart failure with preserved ejection fraction in asymptomatic patients. The purpose of this study was to assess the relationship of LA function, particularly reservoir function, with LA structural remodeling related to the left ventricular (LV) dysfunction in asymptomatic patients with hypertension (HT) using conventional, tissue Doppler, and 2-D speckle-tracking echocardiography. Fifty age-matched healthy individuals and 140 patients with HT, including 75 with LA volume index (LAVI)<29 ml/m2 (normal LA group) and 65 with LAVI≥29 ml/m2 (large LA group), were enrolled. We defined peak early diastolic transmitral flow velocity/peak early diastolic mitral annular motion velocity (E/e')/peak systolic LA strain (S-LAs) as LA diastolic stiffness. The LV mass index, relative LV wall thickness, peak atrial systolic transmitral flow velocity, LA total, active, and passive emptying volume indexes, and E/e'/S-LAs were greatest, and S-LAs, peak early diastolic LA strain, peak systolic LV longitudinal strain and circumferential strain rate, and peak early diastolic LV radial strain rate were lower in the large LA group compared with control and/or normal LA group. Multivariate linear regression analysis revealed that aging, LA remodeling, and LV systolic and diastolic dysfunction are defined as strong predictors related to increased LA diastolic stiffness in the large LA group. HT alters LA dynamics significantly, with resultant increased LA volume and diastolic stiffness related to LV diastolic and systolic dysfunction, even in asymptomatic patients. Earlier treatment with renin–angiotensin system inhibitors may improve abnormal LA-LV interaction in this patient population.