Impact of Arterial Hypertension on Left Atrial Size and Function

Abstract

An increase in left atrial (LA) size in patients with arterial hypertension (AHT) has long been known to be associated with worse cardiovascular morbidity and mortality contributes to various complications, including atrial arrhythmias, stroke, and heart failure. The aim of our study was to evaluate the impact of arterial hypertension (AHT) on the LA size and function. This cross-sectional investigation included one hundred patients with essential hypertension without valvular or structural heart disease and atrial fibrillation. All recruits had a transthoracic echocardiography. LA volumes were measured by area-length method in transthoracic echocardiography at different cardiac cycle times. The indices of LA function were calculated: the reservoir function (total emptying fraction, total emptying volume, and expansion index), the conduit function (passive emptying fraction and passive emptying volume), and the pump function (active emptying fraction and active emptying volume). For all statistical tests, a p value ≤0.05 (represents the degree of significance) is considered statistically significant. In univariate analysis, LA was dilated in 9% of patients. The LA reservoir function and the pump function were increased, respectively, in 85% and 82% of patients. LA conduit function was impaired in 80% of patients. In bivariate analysis, the most powerful factors for this repercussion were diabetes (LA volume MAX dilated in nondiabetic patients (p=0.037)), obesity (the reservoir function was impaired in obese patients (p=0.015)), and antihypertensive drugs (the reservoir function was impaired in patients who take beta blockers (p=0.023); the LA pump function was significantly impaired in patients treated with calcium antagonists (p=0.012)). This study proved the impact of AHT on the LA size and function. Further investigations are necessary to evaluate the potential predictive value of LA remodeling in hypertensive patients like speckle tracking imaging.

Assessing the causal role of hypertension on left atrial and left ventricular structure and function: A two-sample Mendelian randomization study

“…The LA function, including LAAEF, LAPEF, and LATEF, was decreased. These findings are in line with earlier studies showing a significant association between hypertension and LA volume and function ( 4 , 6 ). Ikejder et al ( 4 ) conducted a cross-sectional investigation on the evaluation of the relationship between hypertension and LA volume and function.…”

“…These findings are in line with earlier studies showing a significant association between hypertension and LA volume and function ( 4 , 6 ). Ikejder et al ( 4 ) conducted a cross-sectional investigation on the evaluation of the relationship between hypertension and LA volume and function. Using two-dimensional echocardiography, the investigation showed increases in LA reservoir function and pump function, while the LA conduit function decreased.…”

“…The Pressioni Monitorate E Loro Associazion (PAMELA) study reported a similar conclusion of progressive increase from normotensive to pre-hypertension and hypertension groups in the incidence of LV hypertrophy ( 3 ). In recent years, there have been several articles in cardiology literature on hypertension and LA size and function ( 4 , 5 ). A genetic study about the LA, initiated by Ahlberg et al ( 6 ), showed that systolic blood pressure had a significant effect on LA volume and function.…”

Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease

“…As the application of STE to LA and RV has been increasingly performed for the evaluation of HF, valvular disease, hypertension, etc. [ 78 – 80 ] showing great feasibility regardless of the operator's experience [ 81 ], it has also recently been extended to patients with CAD.…”

Editorial for “Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI”

“…Numerous observational studies have demonstrated the prognostic utility of speckle tracking echocardiography (STE)-derived LA strain parameters in cardiovascular conditions including mitral regurgitation (MR) and hypertension. [2][3][4] In these pathologies, accurate assessment of LV dysfunction using standard parameters such as LV ejection fraction (EF) may be challenging due to the presence of LV volume loading and thus pseudo-preservation of EF until relatively late in the disease course. Moreover, echocardiographic assessment of the LA via STE has proven technically challenging to-date due non-standard acoustic windows, adjacent anatomical structures and the thin wall of the LA.…”