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.

Keywords

Hypertension left atrial strain left atrial volume central blood pressure atrial fibrillation

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References

Tsang

Barnes

Bailey

et al.

Left atrial volume: Important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 2001; 76: 467–475.

Hoit

. Left atrial size and function: Role in prognosis. J Am Coll Cardiol 2014; 63: 493–505.

Kojima

Kawasaki

Tanaka

et al.

Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: Velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging 2012; 13: 227–234.

Milan

Puglisi

Magnino

et al.

Left atrial enlargement in essential hypertension: Role in the assessment of subclinical hypertensive heart disease. Blood Press 2012; 21: 88–96.

Mondillo

Cameli

Caputo

et al.

Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 2011; 24: 898–908.

Cameli

Mandoli

Ambrosio

et al.

Arterial hypertension and atrial fibrillation: Standard and advanced echocardiography from diagnosis to prognostication. J Cardiovasc Med 2018; 19: 51–61.

Kirchhof

Benussi

Kotecha

et al.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893–2962.

Sharman

Laurent

. Central blood pressure in the management of hypertension: Soon reaching the goal? J Hum Hypertens 2013; 27: 405–411.

Braunauer

Pieske-Kraigher

Belyavskiy

et al.

Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function. Int J Cardiovasc Imaging 2018; 34: 701–711.

10.

Tsang

Barnes

Gersh

et al.

Prediction of risk for first age-related cardiovascular events in an elderly population: The incremental value of echocardiography. J Am Coll Cardiol 2003; 42: 1199–1205.

11.

Sharman

Marwick

Abhayaratna

et al.

Rationale and design of a randomized study to determine the value of central Blood Pressure for GUIDing managEment of hypertension: The BP GUIDE study. Am Heart J 2012; 163: 761–767.

12.

WHO Collaborating Centre for Drug Statistics Methodology. Oslo, Norway: Norwegian Institute of Public Health, www.whocc.no/ddd/definition_and_general_considera (2018, accessed 10 January 2019).

13.

Sharman

Lim

Qasem

et al.

Validation of a generalized transfer function to noninvasively derive central blood pressure during exercise. Hypertension 2006; 47: 1203–1208.

14.

Sharman

Avolio

Baulmann

et al.

Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization. Eur Heart J 2017; 38: 2805–2812.

15.

Lang

Badano

Mor-Avi

et al.

Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 233–271.

16.

Nagueh

Smiseth

Appleton

et al.

Recommendation for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277–314.

17.

Jenkins

Bricknell

Hanekom

et al.

Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol 2004; 44: 878–886.

18.

Morris

Takeuchi

Krisper

et al.

Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 2014; 16: 364–372.

19.

Sugimoto

Robinet

Dulgheru

et al.

Echocardiographic reference ranges for normal left atrial function parameters: Results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2018; 19: 630–638.

20.

Chen

Fetics

Nevo

et al.

Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 2001; 38: 2028–2034.

21.

Pathan

Sivaraj

Negishi

et al.

Use of atrial strain to predict atrial fibrillation after cerebral ischemia. JACC Cardiovasc Imaging 2018; 11: 1557–1565.

22.

Pagola

González-Alujas

Flores

et al.

Left atria strain is a surrogate marker for detection of atrial fibrillation in cryptogenic strokes. Stroke 2014; 45: e164–e166.

23.

Nakanishi

Jin

Russo

et al.

Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 2017; 24: 392–398.

24.

Jankowski

Kawecka-Jaszcz

Czarnecka

et al.

Aortic Blood Pressure and Survival Study Group. Pulsatile but not steady component of blood pressure predicts cardiovascular events in coronary patients. Hypertension 2008; 51: 848–855.

25.

Gasowski

Fagard

Staessen

et al.

INDANA Project Collaborators. Pulsatile blood pressure component as predictor of mortality in hypertension: A meta-analysis of clinical trial control groups. J Hypertens 2002; 20: 145–151.

26.

Lantelme

Laurent

Besnard

et al.

Arterial stiffness is associated with left atrial size in hypertensive patients. Arch Cardiovasc Dis 2008; 101: 35–40.

27.

Janwanishstaporn

Boonyasirinant

. Correlation between aortic stiffness and left atrial volume index in hypertensive patients. Clin Exp Hypertens 2016; 38: 160–165.

28.

Rojek

Rajzer

Wojciechowska

et al.

The relation between blood pressure components and left atrial volume in the context of left ventricular mass index. Medicine (Baltimore) 2017; 96: e9459.

29.

Kalaycıoğlu

Gökdeniz

Aykan

AÇ

et al.

Ambulatory arterial stiffness index is associated with impaired left atrial mechanical functions in hypertensive diabetic patients: A speckle tracking study. Anatol J Cardiol 2015; 15: 807–813.

30.

Jaroch

Rzyczkowska

Bociaga

et al.

Arterial-atrial coupling in untreated hypertension. Blood Press 2015; 24: 72–78.

31.

Morris

Gailani

Vaz Pérez

et al.

Left atrial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr 2011; 24: 651–662.

32.

Laurent

Boutouyrie

Lacolley

et al.

Structural and genetic bases of arterial stiffness. Hypertension 2005; 45: 1050–1055.

33.

Aktürk

Ermis

Yağmur

et al.

Early left atrial mechanics and volume abnormalities in subjects with prehypertension: A real time three-dimensional echocardiography study. Echocardiography 2012; 29: 1211–1217.

34.

Negishi

Yang

Wang

et al.

Importance of calibration method in central blood pressure for cardiac structural abnormalities. Am J Hypertens 2016; 29: 1070–1076. .