The relation between blood pressure components and left atrial volume in the context of left ventricular mass index

Abstract

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females-66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e') (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.

Association of central blood pressure with left atrial structural and functional abnormalities in hypertensive patients: Implications for atrial fibrillation prevention

“…24,25 The associations between PP or other measures of arterial stiffening and left atrium size have been demonstrated previously in a number of works; 26,27 however, contrasting results, with a steady component of BP – mean BP being the only haemodynamic determinant of LAVI – have also been reported. 28 Conversely, the data on analogous interactions with respect to left atrium performance are scarce. 29 This study provides incremental information over prior papers by a comprehensive analysis of an array of potential contributors to left atrium strain impairment in the early stage of HHD, as well as by a collective assessment of the relationships between central/peripheral haemodynamics and derangements of both function and size of the left atrium.…”

Formula to estimate left atrial volume using antero-posterior diameter in patients with catheter ablation of atrial fibrillation

“…Volume measurements were made after integrating CT images into the Carto Biosense Webster or NAVX Saint-Jude system, on the three-dimensional reconstructions of the LA and pulmonary veins. The atrial volume was measured outside the venous ostia, without including the pulmonary veins and left appendage, [11] in end-systole when the LA is at its maximum size. All echography and CT measurements were performed before the ablation procedure.…”

Exercise with blood flow restriction: an effective alternative for the non‐pharmaceutical treatment for muscle wasting

“…muscle hypertrophy) in many patients . However, moderate to high intensity RT may not be suitable for physically frail patients due to the significant cardiorespiratory stress or after joint surgery due to the high mechanical load . In this regard, alternative therapeutic approaches that may induce lower cardiovascular stress and joint load, while counteracting muscle wasting, in physically frail patients should be considered.…”