Early detection of left atrial dysfunction in hypertensive patients: Role of Speckle Tracking imaging
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Abstract
Introduction: Systemic hypertension is a major health problem worldwide, it is associated with impaired left atrial (LA) function. Myocardial
deformation analysis using speckle-tracking echocardiography has emerged as a promising tool to evaluate atrial deformation and function.
Aim: To evaluate early changes in left atrial longitudinal strain based on speckle tracking echocardiography in patients with hypertension.
Methods: LA strain was studied using speckle-tracking echocardiography in 109 hypertensive patients without LA enlargement and 50 agematched controls. Conventional and bidimensional strain echocardiographic assessments were performed and the following parameters were
measured: peak atrial longitudinal strain and strain rate during the reservoir, conduit, and contractile periods in four and two-chambers views
and time to peak atrial longitudinal strain/strain rate measured in the three phases of LA function.
Results: LA anteroposterior diameter was within the normal range, no difference between the hypertensive patients and controls was noted
(34.35 mm ±4.91 vs 31.82 mm±4.87, p= 0.16). LA maximum volume (41.78ml±10.29 vs 47ml±13.21, p= 0,01), minimum volume (23.95ml±12.18
vs 16.94ml±7.91, p=0,001) were higher in hypertensive patients, and impaired reservoir ( 31.23% ±9.93 vs 46.43% ±11.06, p=0.000) and conduit
functions (14.26%±2.91 vs 21.41%±2.8 , p= 0,000) were noted in hypertensive patients compared to normotensive patients. During the contractile
period, peak strain (16.73% ±3.84 vs 15.29%±2.75 ,p=0,07) and strain rate (-1.89%±0.16, -1.82%±0.21;p=0,54) were higher in hypertensive
patients without reaching the level of significance. Time to peak strain during reservoir period (405.02ms±55.51 vs 387.13ms±47.48, p=0,05)
and duration of diastole (163ms±26 vs 146ms±24, p= 0,04) were significantly higher in hypertensive patients compared to controls. A significant
relationship between the parameters of the volumetric study and those of the bidimensional strain/strain rate study was noted.
Conclusion: Left atrial longitudinal strain during the reservoir and conduit periods is impaired in patients with hypertension despite normal
cavity size and before the detection of other echocardiographic changes. Speckle-tracking echocardiography may be considered a promising
tool for the early detection of LA strain abnormalities in these patients.
deformation analysis using speckle-tracking echocardiography has emerged as a promising tool to evaluate atrial deformation and function.
Aim: To evaluate early changes in left atrial longitudinal strain based on speckle tracking echocardiography in patients with hypertension.
Methods: LA strain was studied using speckle-tracking echocardiography in 109 hypertensive patients without LA enlargement and 50 agematched controls. Conventional and bidimensional strain echocardiographic assessments were performed and the following parameters were
measured: peak atrial longitudinal strain and strain rate during the reservoir, conduit, and contractile periods in four and two-chambers views
and time to peak atrial longitudinal strain/strain rate measured in the three phases of LA function.
Results: LA anteroposterior diameter was within the normal range, no difference between the hypertensive patients and controls was noted
(34.35 mm ±4.91 vs 31.82 mm±4.87, p= 0.16). LA maximum volume (41.78ml±10.29 vs 47ml±13.21, p= 0,01), minimum volume (23.95ml±12.18
vs 16.94ml±7.91, p=0,001) were higher in hypertensive patients, and impaired reservoir ( 31.23% ±9.93 vs 46.43% ±11.06, p=0.000) and conduit
functions (14.26%±2.91 vs 21.41%±2.8 , p= 0,000) were noted in hypertensive patients compared to normotensive patients. During the contractile
period, peak strain (16.73% ±3.84 vs 15.29%±2.75 ,p=0,07) and strain rate (-1.89%±0.16, -1.82%±0.21;p=0,54) were higher in hypertensive
patients without reaching the level of significance. Time to peak strain during reservoir period (405.02ms±55.51 vs 387.13ms±47.48, p=0,05)
and duration of diastole (163ms±26 vs 146ms±24, p= 0,04) were significantly higher in hypertensive patients compared to controls. A significant
relationship between the parameters of the volumetric study and those of the bidimensional strain/strain rate study was noted.
Conclusion: Left atrial longitudinal strain during the reservoir and conduit periods is impaired in patients with hypertension despite normal
cavity size and before the detection of other echocardiographic changes. Speckle-tracking echocardiography may be considered a promising
tool for the early detection of LA strain abnormalities in these patients.