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Background  To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance.    Methods  LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%).    Results  Compared with controls, PALS res , PALS cond  and PALSR cond  were significantly reduced in patients with isolated hypertension (all  P  < 0.01) but no significant differences were observed in PALS pump , PALSR pump  and TpS pump -SD% between them (all  P  > 0.05). PALS pump , PALSR pump  and PALSR res  were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all  P  < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all  P  < 0.05), and PALSR pump  was further depressed in patients with both hypertension and PAF ( P  = 0.029). PALSR cond  ≤ 1.475 s − 1  combined with TpS pump -SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845,  P  < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALS pump  ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838,  P  < 0.001). LAVI≥29.3 mL/m 2  was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF.    Conclusions  The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.

Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation