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Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P‐wave dispersion and P terminal force
Author(s) -
Tosun Veysel,
Korucuk Necmettin,
Kılınç Ali Yaşar,
Uygun Turgut,
Altekin Refik Emre,
Güntekin Ünal,
Ermiş Cengiz
Publication year - 2018
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.14041
Subject(s) - dipper , cardiology , medicine , ambulatory blood pressure , diastole , speckle tracking echocardiography , ambulatory , blood pressure , ejection fraction , heart failure
Objective Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on left atrial ( LA ) systolic and diastolic functions using two‐dimensional speckle tracking echocardiography (2D‐ STE ), P‐wave dispersion ( PWD ), and P terminal force ( PTF ) in hypertensive patients. Methods A total of 72 patients and 39 healthy individuals were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Atrial electromechanical delay times, LA strain values were obtained by 2D‐ STE with automated software and compared between the groups. PWD and PTF data were calculated on the electrocardiography. Results Inter‐atrial (dippers: 25.5 ± 3.9, nondippers: 32.2 ± 7.4, P < .001), left‐atrial (dippers: 14.9 ± 3.7, nondippers: 18.2 ± 6.0, P = .016), and right atrial (dippers: 10.5 ± 2.1, nondippers: 14.2 ± 5.2, P < .001) electromechanical delay times were significantly longer in nondippers. LA strain S (dippers: 34.2 [29.7–38.7], nondippers: 27.7 [22.7–32.2], P < .001), LA strain E (dippers: 18.2 [16.6–20.1], nondippers: 14.4 [11.6–16.8], P < .001), and LA strain A (dippers: 15.8 [13.5–17.9], nondippers: 12.7 [9.9–14.5], P < .001) were significantly lower in nondippers. Nondippers also had an increased values of maximum P‐wave duration (dippers: 0.117 [0.10–0.12], nondippers: 0.126 [0.12–0.14], P < .001), PWD (dippers: 0.062 [0.06–0.07], nondippers: 0.069 [0.06–0.08], P = .004), and PTF (dippers: 0.055 ± 0.02, nondippers: 0.066 ± 0.02, P = .02). Conclusion Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.