Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

Abstract

We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m -2 , Po0.01 and 1.4 mm m -2 , P ¼ 0.003, respectively) or LV-CR (by 1.3 mm m -2 , P ¼ 0.003 and 1.6 mm m -2 , P ¼ 0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m -2 , Po0.001 and 3.4 ml m -2 , Po0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m -2 , respectively, Po0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

Association of nighttime hypertension with central arterial stiffness and urinary albumin excretion in dipper hypertensive subjects

“…14 Left atrial diameter was measured by 2D-guided M-mode echocardiography obtained in the parasternal short-axis view at the base of the heart and was indexed for body surface area to provide the left atrial diameter index. 15 The left ventricular mass was computed by the formula introduced by Devereux et al 14 and was indexed by height 2.7 , because of an average body mass index that was above normal limits in this patient population, to provide the left ventricular mass index. The relative wall thickness was estimated as the sum of the interventricular septum and posterior wall thickness divided by the end diastolic left ventricular diameter.…”

Association of Left Ventricular Geometry With Left Atrial Enlargement in Patients With Preserved Ejection Fraction

“…However, controversies still exist regarding the relationship of LAE with individual LV geometry. Current data in this regard lack consensus and range from the association of LAE with only eccentric LVH (EH) 12 or concentric LVH (CH) 13 or both 14 to lack of association with LV geometry. 15 The present study evaluated 47,865 patients with preserved LV ejection fraction (LVEF) to determine whether the various LV geometric patterns are associated with LAE as determined by LA volume adjusted for body surface area or LA volume index (LAVi).…”

“…[12][13][14][15] Similarly, LAE is a common echocardiographic finding in patients with different abnormal LV geometric patterns. However, controversies still exist regarding the relationship of LAE with individual LV geometry.…”

“…[7][8][9][10][11] An independent association of LV mass (LVM) or LVH with LAE has been shown in several studies. [12][13][14][15] Similarly, LAE is a common echocardiographic finding in patients with different abnormal LV geometric patterns. However, controversies still exist regarding the relationship of LAE with individual LV geometry.…”

Editors choice: recent highlights from the journal of human hypertension

“…Hence, atrial structure and/or function have always been a topic of interest in hypertension research. In a study of 339 consecutive untreated hypertensives, Tsioufis et al 20 found that left ventricular mass, but not geometry, was the most important determinant of left atrial size in the early stages of hypertension, rather than any specific left ventricular geometric pattern. Similarly, Milan et al 21 found that blood pressure levels, left ventricular mass and function were found to be best correlated with left atrial volume in mild-to-moderate hypertensive patients.…”