Early detection of left atrial dysfunction in hypertensive patients with normal left atrial size: Role of speckle tracking imaging

Background: Systemic hypertension is a major health problem worldwide; it is associated with impaired left atrial (LA) function. Myocardial deformation analysis using speckle-tracking echocardiography has emerged as a promising tool to evaluate atrial deformation and function. This study aimed to evaluate early changes in left atrial longitudinal strain based on speckle tracking echocardiography in patients with hypertension.

Methods: LA strain was studied using speckle-tracking echocardiography in 109 hypertensive patients without LA enlargement and 50 age-matched controls. Conventional and bidimensional strain echocardiographic assessments were performed and the following parameters were measured: peak atrial longitudinal strain and strain rate during the reservoir, conduit, and contractile periods in four and two-chambers views and time to peak atrial longitudinal strain/strain rate measured in the three phases of LA function.

Results: LA area and anteroposterior diameter were within the normal range, no difference between the hypertensive patients and controls was noted. LA maximum, minimum and pre-atrial volumes were higher in hypertensive patients, and impaired reservoir and conduit functions were noted in hypertensive patients compared to normotensive patients. During the contractile period, peak strain and strain rate were higher in hypertensive patients without reaching the level of significance. Time to peak strain and strain rate and duration of diastole were significantly higher in hypertensive patients compared to controls. A significant relationship between the parameters of the volumetric study and those of the bidimensional strain/strain rate study was noted.

Conclusion: Left atrial longitudinal strain during the reservoir and conduit periods is impaired in patients with hypertension despite normal cavity size and before the detection of other echocardiographic changes. Speckle-tracking echocardiography may be considered a promising tool for the early detection of LA strain abnormalities in these patients.