title: Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size.
abstract: BACKGROUND
  Systemic hypertension and type 2 diabetes mellitus are associated with impaired left atrial (LA) function, but whether LA functional abnormalities also occur in patients with hypertension and diabetes who have normal LA sizes is unknown. The aim of this study was to explore LA strain using speckle-tracking echocardiography in patients with hypertension or diabetes and normal LA size.
  
  
  METHODS
  LA strain was studied by speckle-tracking echocardiography in 155 patients with hypertension or diabetes with LA volume indexes < 28 mL/m(2) (83 with hypertension, 34 with diabetes, and 38 with both diabetes and hypertension) and 36 age-matched controls. The following indexes were measured: peak atrial longitudinal strain, time to peak atrial longitudinal strain, atrial longitudinal strain during early diastole and late diastole, and peak LA strain rate during ventricular systole, early diastole, and late diastole.
  
  
  RESULTS
  Peak atrial longitudinal strain was lower in patients with hypertension (29.0 ± 6.5%) and those with diabetes (24.7 ± 6.4%) than in controls (39.6 ± 7.8%) and further reduced in patients with diabetes and hypertension (18.3 ± 5.0%) (P < .0001). Similar results were found for atrial longitudinal strain during early diastole, atrial longitudinal strain during late diastole, and peak LA strain rate during ventricular systole and early diastole (P < .0001 for all). An inverse trend was found for time to peak atrial longitudinal strain, whereas no differences in peak LA strain rate during late diastole were observed. Two-way analysis of variance showed no interactions between hypertension and diabetes. In multivariate analyses, hypertension and diabetes were both independently associated with decreases in all LA strain and strain rate indexes, with the exception of peak LA strain rate during late diastole.
  
  
  CONCLUSIONS
  LA deformation mechanics are impaired in patients with hypertension or diabetes with normal LA size. The coexistence of both conditions further impairs LA performance in an additive fashion. Speckle-tracking echocardiography may be considered a promising tool for the early detection of LA strain abnormalities in these patients.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Maria Luce
authors.initials: ML
authors.lastname: Caputo
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Palmerini
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003971:Diastole; D042241:Early Diagnosis; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013599:Systole