Mechanism of left a trial enlargement related to ventricular diastolic impairment in hypertension

Background and hypothesis: Systemic hypertension is the leading cause of left ventricular (LV) hypertrophy. The present study aimed to investigate the mechanism of left atrial (LA) enlargement in patients with hypertensive heart disease during cardiac catheterization. Methods: Data were obtained from eight control subjects and seven patients with hypertensive heart disease. Left atrial and LV pressures from catheter-tip micromanometer, and LA and LV volumes from biplane cineangiograms were analyzed during the same cardiac cycle. Results: Left atrial maximal volume were 93 ± 26 ml in patients with hypertensive heart disease and 63 ± 12 ml in control subjects (p<0.05). In patients with hypertensive heart disease, time constant of LV relaxation was significantly greater than that in controls (54 ± 18 vs. 31 ± 16 ms, respectively p<0.01). Left atrial maximal volume correlated with time constant of LV relaxation (r = 0.86, p<0.01). The ratio of LV filling volume before LA contraction to LV stroke volume in patients with hypertensive heart disease was significantly lower than that in control subjects (65 ± 13 vs. 76 ± 7%, respectively p<0.05). On the other hand, the ratio of LV filling volume during LA contraction to stroke volume in patients with hypertensive heart disease was significantly higher than that in controls (35 ± 13 vs. 24± 7%, respectively p<0.05). Left atrial volume before LA contraction in patients with hypertensive heart disease was significantly larger than that in controls (74 ± 22 vs. 47 ± 10 ml, respectively, p<0.01). During LA contraction, LA work was significantly increased in patients with hypertensive heart disease compared with that in controls (274 ± 101 vs. 94 ± 42 mmHg. ml, respectively p<0.001). Left atrial work showed significant correlation with LA volume before LA contraction (r = 0.75, p <0.01). Conclusion: Left ventricular diastolic filling was impaired in patients with hypertensive heart disease. Enlargement of left atrium might be attributed to the impairment of blood flow from left atrium to left ventricle due to the increased LV stiffness.     

Relationship Between Exercise Heart Rate Recovery and Circadian Blood Pressure Pattern

J Clin Hypertens (Greenwich). 2010;12:407–413. ^©2010 Wiley Periodicals, Inc. The aim of the present cross-sectional study was to evaluate heart rate recovery (HRR) in normotensive and hypertensive individuals with either nondipper or dipper type circadian rhythm of blood pressure. Eighty-five patients were divided into 4 groups according to the presence of hypertension and pattern of circadian blood pressure as follows: (1) normotensive/dipper, n=20; (2) normotensive/nondipper, n=21; (3) hypertensive/dipper, n=22; and (4) hypertensive/nondipper, n=22. HRR indices were calculated by subtracting first, second, and third minute heart rates from the maximal heart rate obtained during stress testing and designated as HRR1, HRR2, and HRR3. Mean HRR1 values (29.7±4.0 vs 26.6±3.7, P=.016) were significantly higher in the normotensive/dipper group than the normotensive/nondipper group. Mean HRR1 values (28.6±4.0 vs 24.8±4.6 beats per minute, P=.007) were higher in the hypertensive/dipper group than the hypertensive/nondipper group. Spearman’s correlation analyses revealed a positive correlation between degree of nighttime dipping and HRR1 (r=.600, P=.001). The correlation coefficient between degree of nighttime dipping and HRR1 was higher in the hypertensive group than the normotensive group (r=.676, P=.001 and r=.575, P=.001, respectively). Blunting of the nocturnal fall in blood pressure associates with a delayed recovery of heart rate after graded maximal exercise in both normotensive and hypertensive groups.     

Association of the plasma aldosterone concentration,left atrial deformation and ambulatory blood pressure in never-treated early hypertensive patients

Left atrial (LA) strain is known to exhibit an early progressive reduction in hypertensive patients with diastolic dysfunction. However, an association of the renin-angiotensin-*aldosterone system (RAAS) with LA deformation has not been found in these patients. We aimed to investigate the association of plasma aldosterone concentration (PAC) and 24-hour ambulatory blood pressure monitoring (ABPM) with LA and left ventricle (LV) deformation in never-treated early hypertensive patients. This cross-sectional study included 101 never-treated subjects who were registered in a working group at The Catholic University of Korea. The patients were divided into a hypertension group (n = 71), which was defined as having a systolic blood pressure (BP) ≥130 mm Hg and/or a diastolic BP ≥80 mm Hg based on ABPM, and a control group (n = 30). Enrolled patients underwent conventional and speckle tracking echocardiography, ABPM, and measurement of pulse wave velocity, PAC, and plasma renin activity. Compared with the control group, the hypertension group had significantly increased PAC, global longitudinal strain (GLS), atrial reservoir strain, atrial pump strain, and atrial systolic strain rate. LA pump strain was independently associated with nighttime systolic BP. PAC was correlated with GLS but not LA deformation in hypertensive patients without clinically apparent target organ damage. The raised LV pressure secondary to the nocturnal systemic pressure overload might be more strongly associated with LA deformation than with the RAAS.     

Role of speckle tracking echocardiography in detecting early left atrial dysfunction in hypertensive patients

Background

Arterial hypertension adversely affects left atrial (LA) size and function, effect on function may precede effect on size. Many techniques were used to assess LA function but with pitfalls.

Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation

Left Atrial Stiffness and Atrial Fibrillation . Introduction: An increased left atrial (LA) stiffness reflects the structural remodeling and deterioration of the LA function. This study was designed to estimate LA stiffness by measuring a combination of the strain and LA pressure in patients undergoing pulmonary vein isolation (PVI) of atrial fibrillation (AF) and to evaluate the influence of the LA stiffness on the cardiac function, serum markers, and recurrence of AF after PVI. Methods: In 155 consecutive patients with AF, the brain natriuretic peptide (BNP) and aminoterminal procollagen type III propeptide (PIIIP) plasma levels were measured before the PVI. The difference between the minimum and maximum LA systolic pressures was directly measured by a transseptal puncture. The ratio of the difference in the LA pressures to the peak systolic LA strain evaluated by speckle‐tracking echocardiography was used as an index of the LA stiffness. Results: The calculated LA stiffness index was related to the BNP level (r_s= 0.444, P < 0.001), E/E′ ratio (r_s= 0.444, P < 0.001), LA volume index (r_s= 0.370, P < 0.001), and PIIIP level (r_s= 0.305, P = 0.002). During a mean follow‐up period of 33.8 ± 12.2 months, 45 patients (29%) presented with AF recurrences. A Cox proportional hazard regression analysis showed the LA stiffness index was an independent predictor of recurrence of AF (HR 2.88; 95% CI 1.75 to 4.73, P < 0.001). Conclusions: In patients with AF, the LA stiffness index is related to left ventricular diastolic dysfunction, LA dilatation, and collagen synthesis and may predict AF recurrences after PVI. (J Cardiovasc Electrophysiol, Vol. 22, pp. 999‐1006, September 2011)     

The relationship between eosinophil and nondipper hypertension

AimsNon-dipper hypertension is associated with increased cardiovascular morbidity and mortality. It is known that eosinophils play an important role in vasoconstriction and thrombosis. We aimed to compare the numbers of eosinophil counts of the patients nondipper versus dipper hypertension.Materials and methodThis study included 70 hypertensive patients. Hypertensive patients were divided into two groups: 35 dipper patients (15 male, mean age 50.94±11.13 years) and 35 non-dipper patients (10 male, mean age 56.11±11.05 years). Concurrent routine biochemical tests and eosinophil count on whole blood count were performed on these patients. These parameters were compared between groups.ResultsNo statistically significant difference was found between two groups in terms of basic characteristics. Baseline characteristics of the study groups were comparable. Nondipper patients had a higher eosinophil and MPV value than dipper patients (148.86±80 vs. 304.57±182 and 7.8±0.12 vs. 9.2±0.2 fl p<0.001, respectively).ConclusionEosinophil count and MPV value are higher in patients with nondipper hypertension when compared to the dippers.     

High‐Sensitivity Cardiac Troponin T Predicts Nondipper Hypertension in Newly Diagnosed Hypertensive Patients

The increased prognostic accuracy of the high‐sensitivity cardiac troponin T (hs‐cTnT) assay vs the conventional cTnT assay has recently been reported in hypertensive patients. The authors aimed to investigate the significance of serum hs‐cTnT marker for prediction of nondipper hypertension (HTN) in hypertensive patients. A total of 317 patients with newly diagnosed HTN were studied. The patients were divided into two groups: 198 dipper hypertensive patients (mean age, 51.7±5.1 years) and 119 nondipper hypertensive patients (mean age, 53.4±7.6 years). Hs‐cTnT and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) were measured in all patients. hs‐cTnT and NT‐proBNP were independent predictors for nondipper HTN (P<.05 for all). The cutoff value of hs‐cTnT obtained by the receiver operator curve analysis was 7.55 ng/L for the prediction of nondipper HTN (sensitivity: 79%, specificity: 70%; 95% confidence interval, 0.769–0.860; P<.001). In patients with HTN, higher serum concentration of hs‐cTnT even within normal range is an independent predictor of nondipper HTN.     

Left atrial appendage function in prediction of paroxysmal atrial fibrilation in patients with untreated hypertension

The onset of AF results in a significant increase in mortality rates and morbidity in hypertensive patients and this rhythm disorder exposes patients to a significantly increased risk of cerebral or peripheral embolisms. Tissue Doppler imaging was found to be useful in early detection of myocardial dysfunction in several diseases. It was shown that tissue Doppler analysis of the walls of the left atrial appendage (LAA) can give accurate information about the function of the LAA in hypertensive patients. In this study, we aimed to investigate and identify the specific predictive parameters for the onset of AF in patients with hypertension with tissue Doppler imaging of LAA. We studied age and sex matched 57 untreated hypertensive patients with paroxysmal atrial fibrillation (PAF) and 27 untreated hypertensive subjects without PAF. With transthoracic echocardiography, diastolic mitral A-velocity and LA maximal volume index which reflects reservoir function of left atrium was measured, with transesophageal echocardiography, LAA emptying velocity (LAA-PW D2) and tissue Doppler contracting velocity of LAA (LAA-TDI-D2) were measured. LA maximal volume index of the groups (22.28?±?3.59?mL/m² in Group 1 versus 20.37?±?3.97?mL/m² in Group 2, p?=?0.07) and diastolic mitral A-velocity [0.93 (0.59–1.84) m/s in patients with PAF versus 0.90 (0.62–1.76) m/s in patients without PAF, p?=?0.26] was not significantly different between study groups, during TEE, LAA-PW D2 (0.31?±?0.04?m/s in Group 1 versus 0.33?±?0.03?m/s in Group 2, p?=?0.034) and LAA-TDI-D2 (0.18?±?0.04?m/s in Group 1 versus 0.21?±?0.05?m/s in Group 2, p?=?0.014) were significantly decreased in Group 1. In this study, we found that in hypertensive PAF patients despite normal global LA functions, LAA contracting function was deteriorated. Tissue Doppler analysis of LAA is clinically usefull approach to detect the risk of developing PAF in hypertensives.     

Comparison of Left Atrial Mechanical Function in Nondipper versus Dipper Hypertensive Patients: A Speckle Tracking Study

Aim: 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 longitudinal systolic and diastolic functions of left atrial (LA) myocardial tissue by means of two‐dimensional speckle‐tracking echocardiography in treated hypertensive patients. Methods: A total of 78 outpatients treated with antihypertensive drugs for at least 1 year 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. Global longitudinal LA strain/strain rate data were obtained by two‐dimensional speckle imaging with automated software and compared between the groups. Results: LA volume index, left ventricular (LV) wall thickness and mass index as well as filling pressure (E/E′) were significantly higher in nondippers (all P < 0.001), whereas systolic tissue velocity (S′) was significantly lower in nondippers. They also had decreased values of mean peak LA strain (dippers = 27.6 ± 5.5% vs. nondippers = 21.5 ± 4.5%, P < 0.001), strain rate during reservoir (dippers = 1.27 ± 0.4/sec vs. nondippers = 0.98 ± 0.3/sec, P = 0.001), and conduit period (dippers = 1.41 ± 0.4/sec vs. nondippers = 1.06 ± 0.3/sec, P < 0.001). Moreover, we found that LA mechanical dysfunction was closely associated with LV mass, filling pressure, and regional LV contractility. Conclusion: Nondipping in treated hypertensive patients was associated with an adverse cardiac remodeling and impaired LA mechanical function. Further studies are warranted to demonstrate the long‐term prognostic significance of these findings.     

Assessment of left atrium and diastolic dysfunction in patients with hypertensive retinopathy: A real-time three-dimensional echocardiography-based study

The fundoscopic examination of hypertensive patients, which is established hypertension-related target organ damage (TOD), tends to be underutilized in clinical practice. We sought to investigate the relationship between retinal alterations and left atrium (LA) volumes by means of real-time three-dimensional echocardiography (RT3DE). Our population consisted of 88 consecutive essential hypertensive patients (age 59.2 ± 1.2 years, 35 males). All subjects underwent a fundoscopy examination and were distributed into four groups according to the Keith-Wagener-Barker (KWB) classification. The four groups (KWB grades 0–3: including 26, 20, 26, and 16 patients, respectively) did not differ with regard to age, gender, or metabolic profile. There were no significant differences between groups with regard to parameters reflecting LV systolic function and diastolic dysfunction (DD) in two-dimensional echocardiography (2DE). Nevertheless, patients in the higher KWB category had higher values of LA volumes (LA maximal volume index, LA minimal volume index, preatrial contraction volume index, LA total stroke volume index, LA active stroke volume index, p < 0.001) regarding RT3DE. There is also a significant relationship between LA active stroke volume index (ASVI) and duration of hypertension (HT) (r: 0.68, p < 0.001). In the logistic regression analysis, ASVI was independent predictors of LV DD in patients with arterial hypertension (HT). Patients with arterial HT were found to have increased LA volumes and impaired diastolic functions. Assessment of the arterial HT patient by using RT3DE atrial volume analysis may facilitate early recognition of TOD, which is such a crucial determinant of cardiovascular mortality and morbidity.     

Oxidative Stress Impairs Endothelial Function in Nondipper Hypertensive Patients

Aims: Essential hypertension, as well as other established cardiovascular risk factors, is associated with endothelial dysfunction. Hypertensive patients with a nondipper circadian pattern have a greater risk of cerebrovascular and cardiovascular complications in comparison with those with a dipper circadian pattern. In this study, we evaluated the association between nondipper pattern and endothelial function in patients with essential hypertension. Methods: We evaluated the forearm blood flow (FBF) response to intraarterial acetylcholine (ACh), an endothelium‐dependent vasodilator, and sodium nitroprusside (SNP), an endothelium‐independent vasodilator, infusions in 190 hypertensive patients stratified according to dipper and nondipper status. The FBF was measured by strain‐gauge plethysmography. Effects of oxidative stress on FBF were evaluated by intraarterial infusion of vitamin C. Ambulatory BP monitorings were obtained by a validated oscillometric device (SpaceLabs 90207 Monitor Inc., Issaquah, WA, USA). Results: Systolic and diastolic blood pressures were higher during daytime and lower during night‐time in dipper subjects than in nondippers. The peak percent increase in ACh‐stimulated FBF was higher in dippers than in nondippers (473% vs. 228%, P < 0.001). The FBF responses to SNP were similar in dipper and nondipper patients. The FBF response to ACh during coinfusion of vitamin C was higher in nondippers rather than in dipper hypertensives. Conclusions: Present data demonstrate that endothelium‐dependent vasodilation is impaired in patients who have nondipper hypertension. The effects of vitamin C on impaired ACh‐stimulated vasodilation support the hypothesis that oxidative stress contributes to endothelial dysfunction of nondipper hypertensive patients.     

Feasibility of Two‐Dimensional Global Longitudinal Strain and Strain Rate Imaging for the Assessment of Left Atrial Function: A Study in Subjects with a Low Probability of Cardiovascular Disease and Normal Exercise Capacity

Background: Two‐dimensional (2D) speckle imaging has shown that it could evaluate not only regional but also global strain (?) and strain rate (SR) of the left and right ventricles. There are no data for global ?/SR imaging for left atrial (LA) function evaluation. Methods: A total of 54 subjects (37 men; mean age, 44 ± 10 years) with normal treadmill exercise stress echocardiography and no coronary risk factors were enrolled. Global longitudinal LA ?/SR data obtained by 2D speckle imaging with automated software (EchoPAC, GE Medical) were compared with LA volumetric parameters. Results: LA ?/SR imaging was acceptable in all patients. Bland‐Altman analysis for these parameters showed no evidence of any systematic difference regarding inter‐ and intraobserver variabilities. Global longitudinal LA strain during systole and peak systolic global longitudinal LA SR were correlated with LA total emptying fraction (EF) (r = 0.399, P = 0.004; r = 0.366, P = 0.008). Global longitudinal LA strain during early diastole and peak early diastolic global longitudinal LA SR were correlated significantly with LA passive EF (r = 0.476, P < 0.001; r = 0.507, P < 0.001). Global longitudinal LA strain during late diastole and peak late diastolic global longitudinal LA SR were not correlated with LA active EF (r = 0.198, P = 0.163; r = 0.265, P = 0.060). Conclusions: Global longitudinal LA ?/SR parameters determined by 2D speckle tracking echocardiography are feasible and reproducible indices for the evaluation of LA function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Comparison of the left atrial appendage flow velocities between patients with dipper versus nondipper hypertension

Objective: In this study, left atrial appendage (LAA) flow velocities of dipper and nondipper hypertensive patients were compared with normal subjects. Methods: Twenty‐three patients with nondipper hypertension (NDH), 25 patients with dipper hypertension (DH), and 25 control subjects with comparable age, gender, and body mass indices were enrolled in the study. A detailed history, physical examination, and routine laboratory tests were obtained on all participants. Standard transthoracic echocardiographic examinations were performed on each subject. In addition, LAAs of all patients were visualized using transesophageal echocardiography. LAA filling and ejection velocities were measured using pulsed‐wave Doppler with the sample volume placed in proximal third of the LAA. The mean LAA ejection velocity in patients with NDH (47.7 + 13.0 cm/sec) was found to be significantly lower relative to the DH (66.3 + 12.9 cm/sec) and the control group (81.7 + 8.0 cm/sec) (P < 0.001). The mean LAA filling velocity in patients with NDH (41.7 + 14.7 cm/sec) was also significantly lower relative to those observed in the DH 58.8 + 9.2 cm/sec) and the control group (67.2 + 7.9 cm/sec) (P<0.001). Conclusion: In NDH patients, LAA filling and ejection flow rates are decreased relative to DH patients and the control group. For patients with NDH detected using ambulatory blood pressure monitoring, more aggressive treatment approach should be considered. Maintenance of LAA function may prevent potential complications secondary to left atrial appendage dysfunction. (Echocardiography 2012;29:391‐396)     

Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking

Background: Even though atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), its etiology remains poorly understood. Several factors are linked to postoperative AF (POAF), including advanced age and systemic inflammation. However, left atrial (LA) contractile dysfunction has not been evaluated in the perioperative scenario. Aim: To evaluate LA function through strain and strain rate in patients with coronary artery disease undergoing CABG and its correlation with POAF. Methods: We studied 70 patients undergoing CABG in sinus rhythm at the time of surgery. Preoperative echocardiography with evaluation of LA strain and strain rate by speckle tracking was performed. The occurrence of POAF was evaluated by continuous monitoring. Baseline and postoperative C‐reactive protein (CRP) levels were measured to evaluate systemic inflammation. Results: After 1‐week follow‐up 26% of subjects developed AF. LA strain s wave (LASs) and LA strain rate s (LASRs) and a wave (LASRa) were significantly decreased in patients who developed POAF: LASs (10 ± 1% vs. 24 ± 1%, P < 0.001), LASRs (0.6 ± 0.1 sec^–1 vs. 1.2 ± 0.1 sec^?1, P < 0.001), LASRa (?0.6 ± 0.1 sec^–1 vs. –1.8 ± 0.1 sec^?1, P < 0.001). LASRs, LASRa, age, and LA volume were independent predictors of POAF. CRP at baseline was similar irrespective of POAF development. Conclusions: LA dysfunction, evaluated by strain and strain rate is an independent predictor of POAF and contributes to classic risk factors like age and atrial volume. (Echocardiography 2011;28:1104‐1108)     

Left ventricular function, cardiac dysrhythmias, atrial activation, and volumes in nondipper hypertensive individuals with left ventricular hypertrophy

BACKGROUND: Arrhythmic patterns and left ventricular geometric adaptations to pressure overload were investigated in 76 patients with untreated borderline-to-moderate sustained essential hypertension studied by 2-dimensional and M-mode echocardiography, 12-lead, Holter, and signal-averaged electrocardiography, and ambulatory blood pressure monitoring. METHODS AND RESULTS: Sixty-two age- and sex-matched normal adults were chosen for data comparison. Hypertrophic hypertensive patients were subdivided into 2 subgroups: 44 patients with nocturnal blood pressure reduction (dippers) and 32 patients without it (nondippers). Common afterload and diastolic function indexes were found to be lower in combined nondipper and dipper groups, but only fractional shortening decreased in nondippers. The number of premature atrial and ventricular contractions per hour was high in dippers and nondippers, with no statistically significant differences between them; atrial and ventricular complex dysrhythmias were similar. Signal-averaged electrocardiography showed a prolonged P-wave duration in dipper and nondipper patients with high atrial volumes but no late ventricular potentials and no difference in quantitative P-wave analysis. Left atrial volumes, P-wave duration, and premature atrial contractions were found to be positively linked to left ventricular hypertrophy. In nondipper patients a linear correlation was observed between left atrial volume and P-wave duration, although supraventricular ectopic activity was connected to left atrial volume enlargement both in dipper and nondipper patients. CONCLUSIONS: These data suggest that the nondipper pattern is not linked to a worse arrhythmogenic substrate; only atrial volume increase may be related to significant supraventricular activity and prolonged atrial activation in nondipper patients, but late ventricular potentials are uncommon in hypertrophic hypertensive patients.     

Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures

Predict AF. Objective: Since predictors of recurrence of atrial fibrillation (AF) after ablation procedures are poorly defined, this prospective study was conducted to assess the value of left atrial (LA) deformation imaging with two‐dimensional speckle‐tracking (2D‐ST) to predict AF recurrences after successful ablation procedures. Methods and results: One hundred and three consecutive patients (age 58.1 ± 16.6 years, 72.8% male) with AF (76 paroxysmal, 27 persistent) and 30 matched controls underwent transthoracic echocardiography and 2D‐ST‐LA‐deformation analysis with assessment of LA‐radial and LA‐longitudinal strain (Sr, Sl), and velocities derived from the apical 4‐ and 2‐chamber views (4CV, 2CV). AF recurrence was assessed during 6 months of follow‐up. For determination of AF‐related LA changes, AF patients were compared to controls and patients with AF recurrences after ablation procedures (n = 30, 29.1%) were compared with patients who maintained sinus rhythm (n = 73, 70.9%). Atrial deformation capabilities were significantly reduced (P < 0.0005) in patients with AF (4CVSl 17.8 ± 13.5%; 4CVSr 22.3 ± 14.9%; 4CV‐velocities 2.53 ± 0.97 seconds) when compared with controls (4CVSl 31.3 ± 12.4%; 4CVSr 30.3 ± 9.1%; 4CV‐velocities 3.48 ± 1.01 cm/s). Independent predictors for AF recurrence after ablation procedures were 2CV‐LA‐global‐strain (Sr, P = 0.03; Sl, P = 0.003), 4CV‐LA‐gobal‐strain (Sr, P = 0.03; Sl, P = 0.02), and regional LA‐septal wall‐Sl (P = 0.008). LA‐global‐strain parameters were superior to regional LA function analysis for the prediction of AF recurrences, with cutoff values (cov), hazard ratios (HR), positive and negative predictive values (PPV, NPV) were: 4CVSl cov, 10.79% (HR 27.8, P < 0.0005; PPV 78.8%, NPV 93.9%), 4CVSr cov, ?16.65% (HR 24.8, P < 0.0005; PPV 69.4%, NPV 96.6%), 2CVSl cov, 12.31% (HR 22.7, P < 0.0005; PPV 75.8%, NPV 95.3%), and 2CVSr cov, ?14.9% (HR 12.9, P < 0.0005; PPV 64.3%, NPV 93.2%). Conclusion: Compared with controls, AF itself seems to decrease LA deformation capabilities. The assessment of global LA strain with 2D‐ST identifies patients with high risk for AF recurrence after ablation procedures. This imaging technique may help to improve therapeutic guiding for patients with AF. (J Cardiovasc Electrophysiol, Vol. 23 p. 247‐255, March 2012.)     

Impairment of Left Atrial Mechanics Is an Early Sign of Myocardial Involvement in Systemic Sclerosis

Background

Left ventricular (LV) diastolic dysfunction is common in systemic sclerosis (SSc). Less is known, however, about left atrial (LA) mechanics in this context. The aim of this study was to investigate the correlation between LV diastolic function and LA mechanics in SSc patients with the use of volumetric and 2-dimensional speckle tracking–derived strain techniques and to compare the results with those obtained in healthy subjects.

The Relationship Between Neutrophil Lymphocyte Ratio and Non-dipper Hypertension

Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with non-dipper hypertension. In this study, NLR between dipper and non-dipper hypertensive patients was compared.This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 non-dipper patients (17 male, mean age 50.6 ± 5.4 years). Transthoracic echocardiography and ambulatory 24-hour blood pressure monitoring were performed on all patients. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. No statistically significant difference was found between the two groups in terms of basic characteristics. Mean NLR was significantly higher among persons with non-dipper compared with dipper patients (3.1 ± 0.95 vs. 1.8 ± 0.52, P < .001). Additionally, leukocytes and monocytes counts were higher in patients with non-dipper hypertension.In conclusion, our results suggest that higher NLR, an emerging marker of inflammation, has a positive correlation with blood pressure and is elevated in non-dippers compared with dippers.     

Association of Left Atrial Strain and Strain Rate Assessed by Speckle Tracking Echocardiography with Paroxysmal Atrial Fibrillation

Background: We hypothesized that contraction of the LA wall could be documented by speckle tracking and could be applied for assessment of LA function. This study tried to identify the association between LA longitudinal strain (LAS) and strain rate (LASR) measured by speckle tracking with paroxysmal atrial fibrillation (PAF). Methods: Fifty‐two patients (61 ± 17 years old, 23 men) with sinus rhythm at baseline referred for the evaluation of episodic palpitation were included. Standard four‐chamber and two‐chamber views were acquired and analyzed off‐line. Peak LAS and LASR were carefully identified as the peak negative inflection of speckle tracking waves after P‐wave gated by electrocardiography. Results: Ten patients (19%) had PAF. LAS, LASR, age, left ventricular end‐diastolic dimension, left ventricular mass, LA volume, and mitral early filling‐to‐annulus early velocity ratio were different between patients with and without PAF. After multivariate analysis, LASR was significantly independently associated with PAF (OR 8.56, 95% CI 1.14–64.02, P = 0.036). Conclusion: Speckle tracking echocardiography could be used in measurements of LAS and LASR. Decreased negative LASR was independently associated with PAF. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Left Ventricular Hypertrophy Determines the Severity of Diastolic Dysfunction in Patients with Nonvalvular Atrial Fibrillation and Preserved Left Ventricular Systolic Function

Regression of left ventricular (LV) hypertrophy (LVH) is known to be related to a lower incidence of stroke in hypertensive patients with nonvalvular atrial fibrillation (NV-AF). However, its mechanism remains controversial. Recently, diastolic dysfunction (DD) was reported to be correlated with ischemic stroke in NV-AF. We hypothesized that hypertension (HTN) and resultant LVH might be associated with the severity of DD in NV-AF. Two hundred and ninety-four patients (204 males, age 66 ± 12 y) with NV-AF with preserved LV systolic function were included. Clinical and echocardiographic data were compared between patients with enlarged left atrial (LA) volume (n == 237) and patients with normal LA. Age (60 ± 12 vs. 67 ± 11 years), sex (male; 81 vs. 62%%), duration of NV-AF (4.1 ± 7.8 vs. 45.7 ± 49.0 months), brain natriuretic peptide (108.3 ± 129.3 vs. 236.1 ± 197.0 pg//mL), right ventricular systolic pressure (24.5 ± 5.5 vs. 33.1 ± 11.1 mmHg), mitral inflow velocity (E [77.4 ± 22.2 vs. 88.3 ± 22.0 cm//s]), LV mass index (LVMI [87.6 ± 22.2 vs. 105.1 ± 23.2 g//m²]), peak systolic mitral annular velocity (S' [7.2 ± 2.0 vs. 5.8 ± 1.8 cm//s]), and mitral inflow velocity to diastolic mitral annular velocity (E//E' [9.8 ± 3.4 vs. 12.1 ± 4.4]) were significantly different between the two groups, respectively (P < 0.05). In multivariate analysis, LVMI was independently correlated with increased LA volume (OR: 1.037 [95%% CI: 1.011–1.063], P < 0.05), whereas HTN was not. LA enlargement, which reflects the severity and chronicity of DD, is independently associated with LVH in patients with NV-AF. Therefore, regression of LVH with anti-hypertensive treatment may lead to improvement of diastolic function and favorable clinical outcomes in hypertensive patients with NV-AF.