Independent parameters of left atrium function in hypertensive heart disease

Abstract

BackgroundThe left atrium reservoir function has an important role in the global cardiac performance and is determined by multiple cardiac and extra‐cardiac factors. A new parameter is introduced, the independent strain, which quantifies left atrium reservoir phase deformation during isovolumetric relaxation.AimsIs evaluated whether independent strain can identify intrinsic atrial myocardial damage in hypertension.Material and MethodsProspective observational study in which echocardiography was done to 50 hypertensive patients and 80 healthy volunteers. Myocardial deformation was evaluated with two‐dimensional speckle tracking and left atrium volumes were calculated whit 3D‐echocardiography.ResultsIn hypertensive patients, the indexed left atrium volume was greater than in the control group (34 ± 7.8 vs 24 ± 4.9 mL/m2); strain of pump (−5.7 ± 2.4% vs −17±3.5%) and reservoir phases (34 ± 9% vs 48 ± 10%) were worst. The minimum left atrium volume was higher (26 ± 10 vs 15 ± 8 mL) and left atrium independent strain was lower in hypertensive patients (4.0% vs 6.5%, P = .001). Left atrium independent strain only correlated with minimum left atrium volume (r = −.31, P = .048).DiscussionThe left ventricle longitudinal performance has an important contributing role in the left atrium reservoir function; despite this finding, the independent strain was unrelated to left ventricle longitudinal function.ConclusionIndependent strain can identify atrial myocyte contractile dysfunction in hypertension given the relative absence of hemodynamic loads during this period. Additionally, quantification of left atrium minimum volume suggests indirectly the presence of atrial myocyte contractile dysfunction.

Myocardial strain in hypertension: a meta-analysis of two-dimensional speckle tracking echocardiographic studies

“…After the initial screening of titles and abstracts, 780 studies were excluded as they did not assess the relation between LV systolic dysfunction and systemic hypertension. Therefore, 110 studies were reviewed; of these, 22 studies fulfilled the inclusion and exclusion criteria and contained sufficient clinical and echocardiographic data to be included in the final review [14–35] (Fig. 1).…”

“…Mean LVM indexed to BSA ranged from 65 AE 14 g/m 2 [28] to 95 AE 20 g/m 2 [34] in normotensive controls and from 83 AE 12 g/m 2 [35] to 141 AE 32 g/m 2 [21] in hypertensive patients. Pooled average LVM index values were 79.1 AE 1.5 g/m 2 in the first group and 100.9 AE 5.2 g/m 2 in the latter one (P < 0.0001).…”

Role of strain echocardiography in patients with hypertension

“…(2010) 75 patients with hypertension and normal LV geometry (mean age 48 ± 11 years, 61% males) and 50 controls 2D-STE LV longitudinal, circumferential, radial strain rate, and torsion rate Reduced longitudinal, circumferential, radial strain rate, increased rotation rate, and extension of untwisting half-time are the sensitive indicators to diagnosis hypertensive patients with early LV diastolic dysfunction Soufi Taleb Bendiab et al [ 40 ] (2017) 200 patients with hypertension and normal LVEF (mean age 61.7 ± 9.7 years, 68% LVH) 2D-STE LVGLS Reduced GLS (> − 17.6%) is associated with long-lasting, uncontrolled hypertension, overweight, diabetes, related metabolic changes, and is more pronounced in patients with LVH Mizuguchi et al [ 47 ] (2008) 70 patients with normal EF and cardiovascular risk factors and 30 age-matched controls 2D-STE LV longitudinal, circumferential, radial strain and strain rate, and torsion The mean peak systolic and early diastolic longitudinal strain and strain rate were lower in the E/A < 1 group. LV myocardial contraction and relaxation were first impaired in the longitudinal direction Left atrial function Salas Pacheco et al [ 48 ] (2019) 50 patients with hypertension and 80 healthy volunteers 2D-STE LA reservoir, contraction, conduit strain, and LVGLS LA strain of pump and reservoir phases, and LA independent strain were lower in hypertensive patients. LA independent strain only correlated with minimum LA volume, and can identify atrial myocyte contractile dysfunction Right ventricular function Pedrinelli et al [ 49 ] (2010) 89 patients with office BP varying from the optimal to mildly hypertensive range 2D-STE RV longitudinal peak strain and strain rate RV peak systolic strain and early diastolic strain rate reduced in the mid-tertile of BP distribution.…”

“…This shows that the earliest abnormality in hypertension appear as a decrease in LA strain, followed by LA dilatation, subclinical LV dysfunction, and finally HF with normal or reduced LVEF [ 2 ]. Salas Pacheco et al [ 48 ] found that in patients with HHD, the indexed LA volume was greater than in the control group (34 ± 7.8 mL/m 2 vs. 24 ± 4.9 mL/m 2 ); strain of pump (− 5.7% ± 2.4% vs. − 17% ± 3.5%) and reservoir phases (34% ± 9% vs. 48% ± 10%) were worst. The minimum LA volume was higher (26 ± 10 mL vs. 15 ± 8 mL) and LA independent strain was lower in hypertensive patients (4.0% vs. 6.5%, P = 0.001).…”

“…STE is more sensitive method to initial changes in myocardial function and independent of the insonation angle, but since the absolute value is affected by the hemodynamic loading condition, the evaluation of LA strain during isovolumic relaxation may reflects a condition independent of the hemodynamic loading and traction by the atrioventricular plain [ 75 ]. In addition, the lower value of independent strain in hypertensive patients shows that there is intrinsic atrial myocyte damage with significant dysfunction in the early stages [ 48 ].…”