title: Association of left atrial reservoir function with left atrial structural remodeling related to left ventricular dysfunction in asymptomatic patients with hypertension: evaluation by two-dimensional speckle-tracking echocardiography.
abstract: Left atrial (LA) structural and functional abnormalities are vital steps on the pathway toward heart failure with preserved ejection fraction in asymptomatic patients. The purpose of this study was to assess the relationship of LA function, particularly reservoir function, with LA structural remodeling related to the left ventricular (LV) dysfunction in asymptomatic patients with hypertension (HT) using conventional, tissue Doppler, and 2-D speckle-tracking echocardiography. Fifty age-matched healthy individuals and 140 patients with HT, including 75 with LA volume index (LAVI)<29 ml/m2 (normal LA group) and 65 with LAVI≥29 ml/m2 (large LA group), were enrolled. We defined peak early diastolic transmitral flow velocity/peak early diastolic mitral annular motion velocity (E/e')/peak systolic LA strain (S-LAs) as LA diastolic stiffness. The LV mass index, relative LV wall thickness, peak atrial systolic transmitral flow velocity, LA total, active, and passive emptying volume indexes, and E/e'/S-LAs were greatest, and S-LAs, peak early diastolic LA strain, peak systolic LV longitudinal strain and circumferential strain rate, and peak early diastolic LV radial strain rate were lower in the large LA group compared with control and/or normal LA group. Multivariate linear regression analysis revealed that aging, LA remodeling, and LV systolic and diastolic dysfunction are defined as strong predictors related to increased LA diastolic stiffness in the large LA group. HT alters LA dynamics significantly, with resultant increased LA volume and diastolic stiffness related to LV diastolic and systolic dysfunction, even in asymptomatic patients. Earlier treatment with reninangiotensin system inhibitors may improve abnormal LA-LV interaction in this patient population.
authors: Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization , Tokushima , Japan and.
authors: Hirokazu
authors: H
authors: Miyoshi
authors: Yoshifumi
authors: Y
authors: Oishi
authors: Yukio
authors: Y
authors: Mizuguchi
authors: Arata
authors: A
authors: Iuchi
authors: Norio
authors: N
authors: Nagase
authors: Nusrat
authors: N
authors: Ara
authors: Takashi
authors: T
authors: Oki
mesh_terms: D016279:Atrial Function, Left; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling / Q000502:physiology*; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives
chemical_list: C017985:progabide; D005680:gamma-Aminobutyric Acid
keywords: 2-D speckle-tracking echocardiography; Hypertension; LA remodeling; LA reservoir function; LV dysfunction