Background: To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance. Methods: LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%). Results: Compared with controls, PALS res , PALS cond and PALSR cond were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALS pump , PALSR pump and TpS pump -SD% between them (all P > 0.05). PALS pump , PALSR pump and PALSR res were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSR pump was further depressed in patients with both hypertension and PAF (P = 0.029). PALSR cond ≤ 1.475 s − 1 combined with TpS pump -SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALS pump ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m 2 was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF.
Conclusions:The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.