Role of speckle tracking echocardiography in detecting early left atrial dysfunction in hypertensive patients

Abstract

BackgroundArterial hypertension adversely affects left atrial (LA) size and function, effect on function may precede effect on size. Many techniques were used to assess LA function but with pitfalls.ObjectivesEarly detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size.Patients and methodsThe study was conducted on 50 hypertensive patients and 50 age matched normotensive controls, all with normal LA volume index and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study with assessment of LA functions [total LA stroke volume, LA expansion index by conventional 2D echocardiography and Global peak atrial longitudinal strain by speckle tracking (PALS)], left ventricular (LV) systolic and diastolic functions, and LV mass.ResultsDifferent indices of LA dysfunction (Total LA stroke volume, LA expansion index and global PALS) were significantly lower in the hypertensive group despite the normal LA volume index in all the studied subjects. The presence of diabetes mellitus (DM) and higher grade of LV diastolic dysfunction were significantly associated with lower global PALS. The higher age, systolic blood pressure (BP), body mass index (BMI), LA volume index, and LV mass index and the lower LA expansion index were associated with lower global PALS.ConclusionSpeckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs.

Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure

“…In patients with HF (both with preserved and reduced LVEF), enlargement of the LA may be the result of increased resistance to LA emptying into a stiff left ventricle 9,20–23 . Although LA volume is related to LA dysfunction, its ability to detect LA dysfunction in its early stages was shown to be lower than LA strain 5,10,24,25 . Furthermore, studies in HF imply that LA function measured by LA strain can be abnormal even with a normal LA volume 6,7,26–28 .…”

“…9,[20][21][22][23] Although LA volume is related to LA dysfunction, its ability to detect LA dysfunction in its early stages was shown to be lower than LA strain. 5,10,24,25 Furthermore, studies in HF imply that LA function measured by LA strain can be abnormal even with a normal LA volume. 6,7,[26][27][28] In line with these findings, our analysis demonstrates superior performance of LA strain for predicting severe diastolic dysfunction when compared with volumetric measurements, and this correlation was independent from LVEF measures.…”

Advanced echocardiography techniques (AETs) to assess left atrial structure and function in individuals with resistant hypertension

“…The sample size was calculated based on the S-LAr considering a normal mean value of 41.36% 23 and an expected difference of at least seven points between the extreme groups (N and RH) and the intermediate group (CH) given a variability of 6.92% in S-LAr among hypertensive patients. 23 A power of 95% was assumed for the sample calculation for all the primary parameters of the study. The sample was calculated assuming that analysis of variance (ANOVA) would be run to compare groups with a two-tailed test.…”

Relation between left atrial structure and lacunar infarction in patients with hypertension

“…In recent years, the size and function of the left atrium have been clinically valued, and many diseases such as stroke [ 16 ], atrial fibrillation [ 17 ], hypertension [ 18 , 19 ], acute myocardial infarction [ 20 ] and mitral regurgitation [ 21 ] can affect the basic function of LA. The relationship between atrial fibrillation and cerebral infarction is clear.…”