Association of central blood pressure with left atrial structural and functional abnormalities in hypertensive patients: Implications for atrial fibrillation prevention

Abstract

Aims Functional and structural abnormalities of the left atrium have been demonstrated to be clinically and prognostically significant in a range of cardiovascular disorders, increasing the risk of atrial fibrillation. Among the potential contributors to these aberrations, central arterial factors remain insufficiently defined. Accordingly, we sought to investigate the determinants of left atrium abnormalities in hypertension, with special focus on central haemodynamics. Methods In this retrospective, cross-sectional study, 263 patients (age 63.8 ± 8.0 years) with uncomplicated hypertension underwent echocardiography including left atrium strain (LAS) and volume analysis, and central haemodynamics assessment using radial tonometry. Results Patients were grouped depending on LAS and left atrium volume index (LAVI), using externally validated cutpoints (34.1% for LAS and 34 ml/m2 for LAVI). The subset with lower LAS ( n = 124) demonstrated higher central (cPP) and brachial pulse pressure (bPP), ventricular- arterial coupling, left ventricular mass index (LVMI) and LAVI, and lower global left ventricular longitudinal strain and early diastolic tissue velocity (e′). Patients with higher LAVI ( n = 119) presented higher systolic blood pressure, cPP, bPP, central augmentation pressure, LVMI and E/e′ ratio and lower LAS. In multivariable analysis, cPP was independently associated with both LAS ( β = –0.22; p = 0.002) and LAVI ( β = 0.21; p = 0.003). No independent associations with left atrium parameters were shown for bPP. Conclusion Higher cPP is detrimentally associated with left atrium structural and functional characteristics, thus providing a possible pathophysiological link with the development of substrate for atrial fibrillation. Prophylaxis of atrial fibrillation might be another argument for consideration in the treatment strategy in hypertension targeted measures addressing central blood pressure.

Association of arterial hemodynamics with left ventricular systolic function in hypertensive patients: A longitudinal study

“…Impairment in GLS represents the first step in the cascade of LV remodeling in the natural history of HHD, and may parallel or even precede other clinical forms of myocardial affection such as LV hypertrophy, diastolic dysfunction, or left atrial structural and functional abnormalities. [37][38][39][40][41][42] Conversely, LV circumferential performance deteriorates in more advanced stages of the disease, and may even increase the asymptomatic phase of heart failure (stage B) to compensate for the dysfunction in the longitudinal direction. 10,[43][44][45][46][47][48] This paper demonstrated that changes in LV longitudinal systolic deformation over follow-up were associated with alterations in relevant LV afterload-associated indices, among which central augmentation pressure remained an independent predictor after multivariable adjustments for possible confounders.…”

The reward of understanding risk in atrial fibrillation

“…Studies of treatment heterogeneity patterns across systems could also benefit from a quantification of risk to understand how treatments vary across both a system and a spectrum of risk. Clinical risk scores such as Admit-AF might also be integrated with other diagnostic modalities (such as hemodynamic and imaging data) 13 to develop a more robust picture of a patient's condition which may result in more accurate models.…”

The left atrium: A reservoir and a witness for risk of symptoms and cardiovascular complications

“…In the current edition of the journal, Przewlocka-Kosmala et al. 12 nicely report the correlation between increased central blood pressure and left atrium structural and functional abnormalities. With respect to pulse pressure, central blood pressure should be less dependent on large arteries’ stiffness than on peripheral haemodynamics.…”

“…In their work, Przewlocka-Kosmala et al. 12 add another element to the complex landscape of cardiac pathophysiology, by stressing the relationship between left atrium reservoir function and LV afterload. Large peripheral arteries might be abnormal for different reasons and can impact on the heart in different ways.…”

“…5,10,11 Therefore, a combined Industry Task Force, the American Society of Echocardiography and the European Association for Cardiovascular Imaging have worked on a consensus paper that is now available and that is promoting the use of speckle tracking echocardiography for the assessment of left atrium function. 10,11 In the current edition of the journal, Przewlocka-Kosmala et al 12 nicely report the correlation between increased central blood pressure and left atrium structural and functional abnormalities. With respect to pulse pressure, central blood pressure should be less dependent on large arteries' stiffness than on peripheral haemodynamics.…”