Left atrial stiffness index as a marker of early target organ damage in hypertension

Zhao, Yixiao; Sun, Qiaobing; Han, Jiayu; Lu, Yan; Zhang, Ying; Song, Wei; Cheng, Yunpeng; Cong, Tao; Liu, Yan

doi:10.1038/s41440-020-00551-8

Cited by 25 publications

(25 citation statements)

References 40 publications

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“…Previous studies have revealed that LASI is associated with impaired LA mechanical function (28), a marker of early target organ damage in hypertension (14), and a predictor of recurrence of atrial fibrillation (29,30). High blood pressure leads to a greater afterload of the heart and increases the LV stiffness (31).…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that hypertension induces LV hypertrophy and dysfunction, LA enlargement, and arterial stiffness increase. Recent study has shown that left atrial stiffness index (LASI), which is defined as the ratio of transmitral flow velocity in early diastole to mitral annular myocardial velocity (E/e′)/peak systolic LA strain, is the indicator of both LA stiffness and LA–LV coupling, and furthermore, LASI can be recognized as an early marker of TOD in hypertension ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

Sun

Zhao

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveHypertension (HT) induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. In this study, we investigated the association between LA-LV–arterial coupling and nighttime systolic blood pressure (BP) as well as BP circadian rhythm in essential hypertension.MethodsWe enrolled 290 HT patients. All subjects were evaluated by 2- dimensional speckle tracking echocardiography (2DSTE), ambulatory 24 h BP monitoring (ABPM), and brachial–ankle pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers (n = 111), patients with a >10% reduction in BP at nighttime; non-dippers (n = 179), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LAS−S), LA conduit strain (LAS−E), and LA booster pump strain (LAS−A). LA stiffness index (LASI) defined as the ratio of E/e′ to LAS−S, and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV–arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes.ResultsLeft atrial stiffness index was significantly higher in non-dippers [0.29 (0.21, 0.41)] than in dippers [0.26 (0.21, 0.33)] (P < 0.05). PWV/GLS was significantly higher in non-dippers [−80.9 (−69.3, −101.5)] than in dippers [−74.2 (−60.2, −90.6)] (P < 0.05). LAS−S, LAS−E, LAS−A,and LV GLS were significantly lower in non-dippers than in dippers (P < 0.05). Multivariate linear regression analysis revealed that nighttime systolic BP was independently correlated with LASI and PWV/GLS, even adjusted for multiple clinical risk factors, LVMI, and LVEF.ConclusionsThe dipping pattern of BP was related to the abnormalities of myocardial mechanics and LA-LV–arterial coupling. However, absolute nocturnal systolic BP value maybe more important than BP circadian profile in the progression of abnormal LA-LV–arterial coupling.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

Sun

Zhao

et al. 2022

Front. Cardiovasc. Med.

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“…This may be because the decline of LA function represents the degree of systemic damage caused by metabolic diseases, especially the cardiovascular system. Previous studies have showed LA function to be a sensitive and reliable prognostic indicator which can be used as a marker of target organ damage in metabolic diseases [ 24 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Reduced mechanical function of the left atrial predicts adverse outcome in pregnant women with clustering of metabolic risk factors

et al. 2021

BMC Cardiovasc Disord

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Introduction The left atrial (LA) strain and strain rate are sensitive indicators of LA function. However, they are not widely used for the evaluation of pregnant women with metabolic diseases. The aim of this study was to assess the LA strain and strain rate of pregnant women with clustering of metabolic risk factors and to explore its prognostic effect on adverse pregnancy outcomes. Materials and methods Sixty-three pregnant women with a clustering of metabolic risk factors (CMR group), fifty-seven women with pregnancy-induced hypertension (PIH group), fifty-seven women with gestational diabetes mellitus (GDM group), and fifty matched healthy pregnant women (control group) were retrospectively evaluated. LA function was evaluated with two-dimensional speckle-tracking imaging. Iatrogenic preterm delivery caused by severe preeclampsia, placental abruption, and fetal distress was regarded as the primary adverse outcome. Results The CMR group showed the lowest LA strain during reservoir phase (LASr), strain during contraction phase (LASct) and peak strain rate during conduit phase (pLASRcd) among the three groups (P < 0.05). LA strain during conduit phase (LAScd) and peak strain rate during reservoir phase (pLASRr) in the CMR group were lower than those in the control and GDM groups (P < 0.05). Multivariable Cox regression analysis demonstrated systolic blood pressure (HR = 1.03, 95% CI 1.01–1.05, p = 0.001) and LASr (HR = 0.86, 95% CI 0.80–0.92, p < 0.0001) to be independent predictors of iatrogenic preterm delivery. An LASr cutoff value ≤ 38.35% predicted the occurrence of iatrogenic preterm delivery. Conclusions LA mechanical function in pregnant women with metabolic aggregation is deteriorated. An LASr value of 38.35% or less may indicate the occurrence of adverse pregnancy outcomes.

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“…LAVI is the only LA parameter evaluated in general clinical practice to re ect LA function. However, LA strain can also be used as a surrogate measurement of LA function [26] and prior studies showed that it might be a predictor of adverse outcomes among HT patients [3,27] or other CVD high risk patients [11,13,28,29]. A 7.9 year follow-up study [30] showed that LA reservoir and conduit strains were impaired in the stroke compared with non-stroke group with similar LAV.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Phasic Function Remodeling During its Enlargement: A Two-Dimensional Speckle-Tracking Echocardiography Study

Chen

Yang

Wei

et al. 2021

Preprint

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Background Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atria thought to represent a “dysfunctioning” atrium, since there is no accepted ‘gold’ standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physic deformation. Materials and methods A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain =Sa+Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between sub-groups in normal LA size with and without hypertension (HT). Results With LAE (from normal size, mild, moderate to severe LAE), the Stot(21.74±5.97,20.75±4.99,20.49±5.27,17.75±4.71, respectively, ANOVA p=0.003) and Sa (11.84±3.92,11.00±3.29,10.11±2.57,8.55±2.88, respectively, ANOVA p<0.001) reduced while Se had no change. In normal sized LA subgroups, Stot (21.35±5.91 vs 23.01±6.02, p=0.008) and Se (9.51±4.41 vs 11.17±4.89, p<0.001) reduced in subjects with HT comparing with those without. Conclusion LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.

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Left atrial stiffness index as a marker of early target organ damage in hypertension

Cited by 25 publications

References 40 publications

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular–Arterial Coupling in Hypertension

Reduced mechanical function of the left atrial predicts adverse outcome in pregnant women with clustering of metabolic risk factors

Left Atrial Phasic Function Remodeling During its Enlargement: A Two-Dimensional Speckle-Tracking Echocardiography Study

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