Skip to main content
SpringerLink
Log in

Left Atrial Strain for Predicting Atrial Fibrillation Onset in Hypertensive Patients

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Introduction

We aimed to find new predictive parameters for atrial fibrillation (AF) onset in hypertensive patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA).

Methods

One hundred and eight patients with essential hypertension (HTN) were prospectively enrolled, from which 67 patients had no other important comorbidities (HTN group), while 41 patients had a recent AF episode, but were in sinus rhythm at the moment of enrollment (HTN and AF group). LA diameters and maximal volume, LV mass, LV ejection fraction and diastolic function were assessed through 2D conventional echocardiography. Moreover, peak longitudinal and contractile strain of LA walls (PALS and PACS, respectively) were analyzed by speckle tracking technique. Patients were followed up for 1 year and recurrent 24-h rhythm monitoring was done, in order to identify atrial fibrillation.

Results

Age and time from diagnosis of HTN were higher in HTN and AF group than in HTN group (68.02 ± 19 years versus 57.2 ± 1.52 years, p = 0.001 and 62.2 ± 9.2 months versus 40.4 ± 6.4 months, p = 0.04). All LA diameters and LA maximal volume were significantly larger in HTN and AF group (for LA antero-posterior diameter p = 0.02, for all the rest p < 0.0001). LV ejection fraction was preserved in both groups, being significantly lower in HTN and AF patients (58.44 ± 0.79 versus 60.75 ± 0.57, p = 0.02). LV mass was higher in HTN and AF group and these patients had also a more severe diastolic dysfunction, (E/A ratio 1.8 ± 0.51 versus 0.9 ± 0.02, p = 0.04) and lower septal and lateral A′ velocities (p < 0.0001 and p = 0.002). The peak LA longitudinal and contractile strain values were also significantly lower in HTN and AF group versus HTN group (for all p < 0.0001). Among the echocardiographic parameters, we identified PALS and PACS as predictors for AF, with a good discriminating capacity (AUC = 0.88 for PALS and AUC = 0.86 for PACS).

Conclusions

Compared to patients with isolated hypertension, patients with hypertension and AF display several echocardiographic differences. Among them, LA strain parameters could be useful predictors of AF occurrence in hypertensive patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, et al. Hypertension and cardiac arrhythmias: Executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society Society (APHRS). Eur Hear J Cardiovasc Pharmacother. 2017;3(March):235–50.

    Google Scholar 

  2. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010;3(3):231–9.

    Article  PubMed  Google Scholar 

  3. Ristow B, Ali S, Whooley M a, Schiller NB. Usefulness of left atrial volume index to predict heart failure hospitalization and mortality in ambulatory patients with coronary heart disease and comparison to left ventricular ejection fraction (from the Heart and Soul Study). Am J Cardiol [Internet]. 2008;102(1):70–6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2789558&tool=pmcentrez&rendertype=abstract. Cited 3 Sept 2014.

  4. Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, et al. Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension. J Am Soc Hypertens [Internet]. 2013;7(3):206–15. http://www.sciencedirect.com/science/article/pii/S1933171113000120. Cited 19 Aug 2014.

  5. Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol [Internet]. 2014;63(6):493–505. http://www.sciencedirect.com/science/article/pii/S0735109713060816. Cited 19 Aug 2014.

  6. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51(8):802–9.

    Article  CAS  PubMed  Google Scholar 

  7. Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation: Doubts and certainties from basic and clinical studies. Circ Res. 2018;122:352–68.

    Article  CAS  PubMed  Google Scholar 

  8. Conen D, Glynn RJ, Sandhu RJ, Tedrow UB, et al. Risk factors for incident atrial fibrillation with and without left atrial enlargement in women. Int J Cardiol. 2013;168(3):1894–9. https://doi.org/10.1016/j.ijcard.2012.12.060.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Qureshi W, Soliman EZ, Solomon SD, Alonso A, et al. Risk factors for atrial fibrillation in patients with normal versus dilated left atria (from the Atherosclerosis Risk in Communities [ARIC] Study). Am J Cardiol. 2014;114(9):1368–72. https://doi.org/10.1016/j.amjcard.2014.07.073.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, et al. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound [Internet]. 2009;7:6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2652427&tool=pmcentrez&rendertype=abstract. Cited 3 Sept 2014.

  11. Cameli M, Ciccone MM, Maiello M, Modesti PA, Muiesan ML, Scicchitano P, et al. Speckle tracking analysis: a new tool for left atrial function analysis in systemic hypertension: an overview. J Cardiovasc Med. 2016;17:339–43.

    Article  Google Scholar 

  12. Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, et al. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr [Internet]. Elsevier Inc; 2011;24(8):898–908. http://www.ncbi.nlm.nih.gov/pubmed/21665431. Cited 3 Sept 2014.

  13. Sahebjam M, Mazareei A, Lotfi-Tokaldany M, Ghaffari N, Zoroufian A, Sheikhfatollahi M. Comparison of left atrial function between hypertensive patients with normal atrial size and normotensive subjects using strain rate imaging technique. Arch Cardiovasc Imaging [Internet]. 2014;2(1):1–6. http://www.cardiovascimaging.com/?page=article&article_id=16081.

  14. To ACY, Flamm SD, Marwick TH, Klein AL. Clinical utility of multimodality la imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging. 2011;4(7):788–98.

    Article  PubMed  Google Scholar 

  15. En A, Sometidos P, Valvular a C, Muñoz NL, Fernández IM, Oca RM De, et al. Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. Rev Colomb Cardiol [Internet]. 2014;10:48. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3583741&tool=pmcentrez&rendertype=abstract; http://www.ncbi.nlm.nih.gov/pubmed/21888129.

  16. Yasuda R, Murata M, Roberts R, Toguda H, Minakata Y, et al. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2015;16(9):1008–14. https://doi.org/10.1093/ehjci/jev028.

    Article  PubMed  Google Scholar 

  17. Donal E, Galli E, Schnell F. Left atrial strain a must or a plus for routine clinical practice? Circ Cardiovasc Imaging. 2017;10:e007023. https://doi.org/10.1161/circimaging.117.007023.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by CREDO Project ID: 49182, financed by the National Authority of Scientific Research and Innovation, on behalf of the Romanian Ministry of European Funds- through the Sectoral Operational Programme “Increasing of Economic Competitiveness”, Priority Axis 2, Operation 2.2.1 (SOP IEC-A2-0.2.2.1-2013-1) cofinanced by the European Regional Development Fund.

Author information

Authors and Affiliations

  1. Department of Cardiology, Clinical Emergency Hospital, Calea Floreasca, No. 8, 014461, Bucharest, Romania

    Ioana Petre, Sebastian Onciul, Silvia Iancovici, Diana Zamfir, Monica Stoian, Alina Scărlătescu, Alexandra Diaconeasa, Camelia Acatrinei & Maria Dorobanțu

  2. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

    Ioana Petre, Sebastian Onciul & Maria Dorobanțu

  3. Anima Medical Clinic, Bucharest, Romania

    Alexandra Diaconeasa

Authors
  1. Ioana Petre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Onciul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia Iancovici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diana Zamfir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monica Stoian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alina Scărlătescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexandra Diaconeasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Camelia Acatrinei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Dorobanțu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioana Petre.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was approved by Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petre, I., Onciul, S., Iancovici, S. et al. Left Atrial Strain for Predicting Atrial Fibrillation Onset in Hypertensive Patients. High Blood Press Cardiovasc Prev 26, 331–337 (2019). https://doi.org/10.1007/s40292-019-00326-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-019-00326-4

Keywords

Search

Navigation