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Effect of an Increase in Left Ventricular Pressure Overload on Left Atrial‐Left Ventricular Coupling in Patients with Hypertension: A Two‐Dimensional Speckle Tracking Echocardiographic Study
Author(s) -
Miyoshi Hirokazu,
Oishi Yoshifumi,
Mizuguchi Yukio,
Iuchi Arata,
Nagase Norio,
Ara Nusrat,
Oki Takashi
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12117
Subject(s) - cardiology , medicine , diastole , speckle tracking echocardiography , asymptomatic , blood pressure , systole , heart failure , ejection fraction
Background Two‐dimensional speckle tracking echocardiography (2 DSTE ) has recently been applied to evaluate left atrial ( LA ) function in addition to left ventricular ( LV ) function. However, whether 2 DSTE can provide insight into LA ‐ LV interaction related to an increase in LV pressure overload remains unknown. Methods One hundred five asymptomatic patients with hypertension were studied by conventional, pulsed and tissue D oppler, and 2 DSTE . Hypertensive patients were classified into 2 groups according to the ratio of early diastolic to atrial systolic velocity (E/A) of transmitral flow: E/A ≥ 1 (n = 37) and E/A < 1 (n = 68). We used (E/peak early diastolic mitral annular motion velocity [e′])/peak systolic LA strain (S‐ LA s) and E/e′, as parameters of LA stiffness during ventricular systole and LV diastolic stiffness, respectively. Results The peak early diastolic LV longitudinal strain rate, and peak early diastolic LA strain and strain rate were lower in the E/A < 1 group than in the E/A ≥ 1 group. The E/e′/S‐ LA s and E/e′ were greater in the E/A < 1 group. In the E/A < 1 group, systolic blood pressure ( SBP ) correlated with LV wall thickness parameters, A, e′, E/e′, peak early diastolic LV longitudinal strain rate, and E/e′/S‐ LA s. Multivariate regression analysis indicated that A, E/e′, and E/e′/S‐ LA s were defined as strong predictors related to SBP . Conclusion In patients with hypertension, an elevation in SBP leads to increased LA stiffness during ventricular systole and LV diastolic stiffness, in association with continued and further advanced LV diastolic dysfunction. 2 DSTE is considered a sensitive tool for detecting abnormal LA ‐ LV coupling related to an increased LV pressure overload.