Early Detection of Left Atrial Dysfunction by Speckle Tracking Echocardiography in Hypertensive Patients with Normal Left Atrial Size

Abstract

Summary M ost of studies on the effect of hypertension on LA included patients regardless of LA size. This raises the question of whether LA dysfunction in patients with hypertension may be detected in the absence of LA enlargement. For many years, LA size was used as a surrogate marker of LA function in clinical practice. Moreover, detection of LA dysfunction before LA enlargement is quite beneficial as it helps in risk stratification of hypertensive patients with the possibility of stopping or reversing the process of LA remodelling through some drugs (RAAS inhibitors). Many echocardiographic methods were used before to assess LA function but with many limitations (e.g. angle dependency). Thus, the novel technique of speckle tracking provides a useful method for better assessment of LA function. The aim of this study was early detection of LA dysfunction (i.e. when LA size is still normal) in hypertensive patients using speckle tracking technique. The study included 50 hypertensive patients and 50 control subjects from Ain Shams University hospitals, all with normal LA size. The selected patients were subjected to thorough history taking, general and local cardiac examination, echocardiography including both conventional parameters and speckle tracking echocardiography. Comparing the 2 groups revealed that LA strain (representing LA function) was significantly reduced in the hypertensive group. Also, further analysis of the results showed that some risk factors and measured parameters were associated with worse LA function in hypertensive patients as older age, higher BMI, DM, LV diastolic dysfunction, higher systolic BP, larger LA size, LA expansion index and LV mass index.