Left atrial function: Correlation with left ventricular function and contractile reserve in patients with hypertension

Fung, M.; Thomas, Liza; Leung, Dominic Y.

doi:10.1111/echo.14051

Cited by 9 publications

(10 citation statements)

References 54 publications

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“…Our study found impaired LA reservoir (decreased εs and SRs) and conduit (decreased εe and SRe) functions in HTN(MR−) patients compared to the controls. This finding conforms to previous reports on hypertensive cases 20,28 . However, the LAV and LAEF were unchanged.…”

Section: Discussionsupporting

confidence: 93%

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Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI

Tang

Shi

Zhi

et al. 2023

Magnetic Resonance Imaging

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BackgroundMitral regurgitation may occur when hypertension causes left ventricular (LV) and left atrial (LA) remodeling. However, its role in LA function in hypertensive patients remains unclear.PurposeTo explore how mitral regurgitation affects LA function in hypertension and to investigate atrioventricular interaction in hypertensive patients with mitral regurgitation.Study TypeRetrospective.PopulationA total of 193 hypertensive cases and 64 controls.Field Strength/SequenceA 3.0 T/balanced steady‐state free precession.AssessmentLA volume (LAV), LA strain (reservoir, conduit, and active), LA ejection fraction, and LV strain (global peak longitudinal [GLS], circumferential [GCS], and radial strain [GRS]) were evaluated and compared among groups. Regurgitant fraction (RF) was evaluated in regurgitation patients and used to subdivide patients into mild (RF: 0%–30%), moderate (RF: 30%–50%), and severe (RF: >50%) regurgitation categories.Statistical TestsOne‐way analysis of variance, Spearman and Pearson's correlation coefficients (r), and multivariable linear regression analysis. A P value <0.05 was considered statistically significant.ResultsHypertensive patients without mitral regurgitation showed significantly impaired LA reservoir and conduit functions and significantly decreased LV GLS but preserved pump function and LAV compared to controls (P = 0.193–1.0). Hypertensive cases with mild regurgitation (N = 22) had significantly enlarged LAV and further reduced LA reservoir function, while the group with moderate regurgitation (N = 20) showed significantly reduced LA pump function, further impaired conduit function, and significantly reduced LV strain. The severe regurgitation (N = 13) group demonstrated significantly more severely impaired LA and LV functions and LAV enlargement. Multivariable linear regression showed that regurgitation degree, GRS, GCS, and GLS were independently correlated with the LA reservoir, conduit, and active strain in hypertensive patients with mitral regurgitation.Data ConclusionMitral regurgitation may exacerbate LA and LV impairment in hypertension. Regurgitation degree, LV GRS, GCS, and GLS were independent determinants of the LA strain in hypertensive patients with mitral regurgitation, which demonstrated atrioventricular interaction.Evidence Level4.Technical EfficacyStage 3.

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Section: Discussionsupporting

confidence: 93%

“…This finding conforms to previous reports on hypertensive cases. 20,28 However, the LAV and LAEF were unchanged. Kokubu et al reported that treatment of hypertension with reninangiotensin system inhibitors restored the LA reservoir strain only when the LA was not enlarged.…”

Section: Characteristics Of La and LV Impairment In Hypertensive Casesmentioning

confidence: 95%

Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI

Tang

Shi

Zhi

et al. 2023

Magnetic Resonance Imaging

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“…Systemic hypertension and diabetes have been shown to be associated with early reduction of all LA myocardial deformation components in subjects with normal LA dimensions (111). In hypertensive patients, the impairment of reservoir, conduit, and contractile function has been related to LV global longitudinal strain (GLS) and contractile reserve explored by dobutamine stress test and confirming the interplay between LA and LV function (112). However, the relationship between LA and LV function is stronger when atrial chamber is not dilated and seems to be less relevant when LA dilatation occurs (113,114).…”

Section: La Mechanics In Hf Stages Stage Amentioning

confidence: 92%

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Bandera

Mollo

Frigelli

et al. 2022

Front. Cardiovasc. Med.

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The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.

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confidence: 99%

“…New echocardiographic parameters such as strain and the strain rate (SR) are closely related to the functional state of the LA and more sensitive in the early detection of its subtle changes. 3,6,7 Strain and the SR represent the magnitude and rate of myocardial deformation. 8 Left atrial strain profiles show 3 LA aspects: passive strain (LA conduit function), active strain (LA pump function), and total strain (LA reservoir function).…”

mentioning

confidence: 99%

Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

Taşar

Kocabay

Karagöz

et al. 2019

J of Ultrasound Medicine

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Objectives We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2‐dimensional speckle‐tracking echocardiography. Methods A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5‐MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). Results Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). Conclusions We prospectively determined normal reference values for LA deformation parameters using speckle‐tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.

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Left atrial function: Correlation with left ventricular function and contractile reserve in patients with hypertension

Abstract: Compared to controls, hypertensive patients had impaired LA strain, which correlated with LV GLS and CR. LV GLS and LAVImax were the strongest independent determinants for LA Ɛs/Ɛe and LA Ɛa, respectively, independent of BP and LVMi.

Cited by 9 publications

References 54 publications

Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI

Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

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