Assessment of subclinical left atrial myocardial dysfunction in essential hypertension patients with normal left ventricle function by two-dimensional strain and volume-derived variables

Purpose: To investigate subclinical left atrial (LA) myocardial dysfunction in essential hypertension (EHT) patients by using volume-derived and two-dimensional strain.

Methods: We enrolled in this study 51 normal subjects and 95 EHT patients. The LA volume-derived index was measured in apical 4- and 2-chamber views. LA strain and strain rate, reservoir, conduit, and booster pump functions were measured by two-dimensional speckle tracking echocardiography (STE).

Results: LA ejection fraction (LAEF) and absolute strain-derived values were significantly lower in EHT patients than in controls. LAEF (total, passive), absolute values of LA strain (S-reservoir and S-conduit), and strain rate (Sr-reservoir and Sr-conduit) were significantly lower in EHT patients with left ventricular hypertrophy (LVH) than in patients without LVH and in controls. However, there were no significant difference in active LAEF or S-booster pump and Sr-booster pump functions between EHT patients without LVH and normal subjects. The areas under the curves of the combination of volume-derived values, LA strain, and strain rate were significantly higher than those of individual indices.

Conclusion: In our population, EHT patients showed impaired LA functions and greater stiffness than normal subjects. EHT patients with LVH showed greater impairment of LA reservoir and conduit functions than patients without LVH. EHT patients without LVH had normal LA booster pump function, which was impaired in patients with LVH. Volume-derived and 2D strain values could provide a sensitive and reproducible method for detecting subclinical LA myocardial dysfunction in EHT.