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. 2018 Oct 31;16(1):29.
doi: 10.1186/s12947-018-0147-6.

Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation

Jonas Jarasunas  1 , Audrius Aidietis  2 , Sigita Aidietiene  2
Affiliations

Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation

Jonas Jarasunas et al. Cardiovasc Ultrasound. .

Abstract

Background: 2D strain imaging of the left atrium (LA) is a new echocardiographic method which allows us to determine contractile, conduit and reservoir functions separately. This method is particularly useful when changes are subtle and not easily determined by traditional parameters, as it is in arterial hypertension and atrial fibrillation (AF).

The aims of our study were: to determine LA contractile, conduit and reservoir function by 2D strain imaging in patients with mild arterial hypertension and paroxysmal AF; to assess LA contractile, conduit and reservoir functions' relation with LV diastolic dysfunction (DD) parameters.

Methods: LA contractile, conduit and reservoir functions together with echocardiographic signs of LV DD were assessed in 63 patients with arterial hypertension and paroxysmal AF. Patients were grouped according to number of signs showing LV DD (annular e' velocity: septal e' < 7 cm/s, lateral e' < 10 cm/s, average E/e' ratio > 14, LA volume index > 34 ml/m2, peak tricuspid regurgitation velocity > 2.8 m/s) present. Number of patients with 0 signs - 17, 1 sign - 26, 2 signs - 19. Contractile, conduit and reservoir functions were compared between the groups.

Results: Mean contractile, conduit and reservoir strains in all the patients were - 14.14 (± 5.83) %, 15.98 (± 4.85) % and 31.03 (± 7.64) % respectively. Contractile strain did not differ between the groups. Conduit strain was higher in patients with 0 signs compared with other groups (p = 0.016 vs 1 sign of LV DD and p = 0.001 vs 2 signs of LV DD). Reservoir strain was higher in patients with 0 signs compared with other groups (p = 0.014 vs 1 sign of LV DD and p < 0.001 vs 2 signs of LV DD).

Conclusions: The patients with paroxysmal AF and primary arterial hypertension have decreased reservoir, conduit and pump LA functions even in the absence of echocardiographic signs of LV DD. With increasing number of parameters showing LV DD, LA conduit and reservoir functions decrease while contractile does not change. LA conduit and reservoir functions decrease earlier than the diagnosis of LV DD can be established according to the guidelines in patients with primary arterial hypertension and AF.

Keywords: Arterial hypertension; Atrial fibrillation; Diastolic dysfunction; Left atrial strain.

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Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by the appropriate ethics committees and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
2D LA strain image from four-chamber apical view. Setting the starting point of strain analysis at the beginning of the p wave on the ECG allowed us to define first negative peak, first positive peak and the difference of these peaks which corresponded to atrial contractile strain, conduit strain and reservoir strain respectively
Fig. 2
Fig. 2
Contractile strain comparison between groups with different number of LV DD signs. There was no significant difference between the groups, p = 0.367
Fig. 3
Fig. 3
Conduit strain comparison between groups with different number of LV DD signs. Group with no signs of LV DD had higher conduit strain values (p = 0.016 vs 1 sign of LV DD and p = 0.001 vs 2 signs of LV DD). Difference between groups with 1 and 2 signs of LV DD were not statistically significant, p = 0.213
Fig. 4
Fig. 4
Reservoir strain comparison between groups with different number of LV DD signs. Group with no signs of LV DD had higher reservoir strain values (p = 0.014 vs 1 sign of LV DD and p < 0.001 vs 2 signs of LV DD). Difference between groups with 1 and 2 signs of LV DD did not meet the cutoff of significance, p = 0.072
Fig. 5
Fig. 5
Scatterplot showing relation between reservoir strain and E/e’. There is significant correlation between marker of LV DD E/e’ and reservoir strain
See this image and copyright information in PMC

References

    1. Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505. doi: 10.1016/j.jacc.2013.10.055. - DOI - PubMed
    1. Lip GY. Atrial fibrillation in patients with hypertension: trajectories of risk factors in yet another manifestation of hypertensive target organ damage. Hypertension. 2016;68:544–545. doi: 10.1161/HYPERTENSIONAHA.116.07901. - DOI - PubMed
    1. Rosenberg MA, Manning WJ. Diastolic dysfunction and risk of atrial fibrillation: a mechanistic appraisal. Circulation. 2012;126(19):2353–2362. doi: 10.1161/CIRCULATIONAHA.112.113233. - DOI - PubMed
    1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339. - DOI - PubMed
    1. Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M, Amano M, Kurabayashi M. Left atrial strain provides incremental value for embolism risk stratification over CHA2DS2-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr. 2014;27:709–716.e4. doi: 10.1016/j.echo.2014.03.010. - DOI - PubMed

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