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Left ventricle hypertrophy (LVH) is a common and powerful risk factor in arterial hypertension, while concentric LVH is considered the most dangerous. It is well known that LV geometry and the dipping status according to 24h ambulatory blood pressure provide independent prognostic informations in hypertensive patients. On the other hand left atrial dilation is associated with increased cardiovascular risk in arterial hypertension. The aim of this study was to evaluate the possible relationship between LA enlargement and LVH, LV, geometry and dipping status. We studied 5175 consecutive untreated patients with essential hypertension. Dippers were 2976 and LVH had 2907 (1087 patients with eccentric and 1820 with concentric LVH), while 1236 patients had concentric remodeling. LA was measured from 2D derived M-mode tracings and LA index was calculated after correction with body surface area. The LA/aortic root ratio was obtained as well. Non-dippers had larger LA in comparison to dippers (35 vs 32 mm, p 0.00001), as did patients with LVH compared to those without LVH (35 vs 31 mm, p 0.00001). LV geometry differentiated LA size (normal geometry 31mm, concentric remodeling 32mm, eccentric LVH 36 mm, concentric LVH 34 mm, F 294, p 0.00001). Dippers without LVH had smaller LA compared to non dippers with LVH 34 mm, F 294, p 0.00001). Dippers without LVH had smaller LA compared to non dippers with LVH (31 vs 36 mm, p 0.00001). Overall, dippers with normal geometry had the smallest LA (30.7 mm) and the non dippers with eccentric LVH had the largest LA (37.4 mm). These findings held true after correcting LA dimension for body surface area or aortic root diameter. It is concluded that LA dimension is related to LV hypertrophy and geometry while 24 h ambulatory blood pressure dipping pattern adds to prognosis.

Left atrial dimension depends on 24 hour ambulatory blood pressure dipping pattern and left ventricular geometry in arterial hypertension