Arterial stiffness is associated with left atrial size in hypertensive patients.
BACKGROUND
Arterial stiffness is a strong predictor of cardiovascular events and particularly of stroke. A likely explanation is the development of atherosclerotic lesions at the carotid level, favored by increased local stiffness. Another possibility involves cardiac consequences of aortic stiffness and particularly left atrial dilatation with its subsequent risk of atrial fibrillation (AF) and cerebral embolism.


OBJECTIVE
The present study investigated the link between arterial stiffness, pulse pressure and left atrial size, a determinant of AF risk.


METHODS
Arterial stiffness was determined from pulse wave velocity (PWV) and pulse pressure (PP). Left atrial size was also measured. Several potential confounders were taken into account including indices of ventricular remodeling and diastolic function (estimated by NT-Pro brain natriuretic peptide (NT-proBNP) levels).


RESULTS
Three-hundred and ten hypertensive patients, aged 53 +/- 13 years, were included. Mean 24-h blood pressure (BP) was 154 +/- 20 over 93 +/- 13 mmHg. Significant relationships were found between left atrial diameter (LAD) and PWV (r=0.27, P<0.001) and between LAD and 24-h PP (r=0.32, P<0.001). LAD was also correlated significantly, although not always tightly, with left ventricular dimensions, geometry and NT-proBNP. In two different multivariate models, LAD remained significantly correlated with PWV or with 24-h PP, independently of classical determinants like age, gender, body mass index, ventricular remodeling (i.e. dimensions and geometry) and filling pressure.


CONCLUSIONS
These results led us to propose AF as a new possible pathophysiological link between arterial stiffness and stroke. These results also emphasize the cardiac consequences of arterial stiffness which can fuel a new approach to AF prevention.
Lantelme
P
P
Service de cardiologie, Hôpital de la Croix-Rousse, Lyon, France. pierrelantelme@hotmail.com
Laurent
S
S
Besnard
C
C
Bricca
G
G
Vincent
M
M
Legedz
L
L
Milon
H
H
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D017536:Carotid Artery, Common / Q000503:physiopathology*; D003971:Diastole; D004548:Elasticity; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011673:Pulsatile Flow; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014463:Ultrasonography; D020257:Ventricular Remodeling
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain