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Published on: October 19, 2016
Arterial stiffness is associated with left atrial size in hypertensive patients
P Lantelme1, S Laurent, C Besnard
1Service de cardiologie, Hôpital de la Croix-Rousse, Lyon, France. pierrelantelme@hotmail.com
Insights
Arterial stiffness, a predictor of stroke, is linked to left atrial enlargement, a risk factor for atrial fibrillation (AF). This suggests AF may connect arterial stiffness to stroke, aiding prevention strategies.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Arterial stiffness is a key predictor of cardiovascular events, particularly stroke.
- Increased arterial stiffness may lead to carotid atherosclerosis or cardiac issues like left atrial enlargement, increasing atrial fibrillation (AF) risk.
Purpose of the Study:
- To investigate the relationship between arterial stiffness, pulse pressure, and left atrial size.
- To explore left atrial size as a determinant of AF risk.
Main Methods:
- Arterial stiffness assessed via pulse wave velocity (PWV) and pulse pressure (PP).
- Left atrial size (diameter, LAD) measured.
- Confounders including ventricular remodeling and diastolic function (NT-proBNP) analyzed.
Main Results:
- Significant positive correlations found between left atrial diameter (LAD) and PWV (r=0.27) and 24-h PP (r=0.32) in 310 hypertensive patients.
- LAD also correlated with left ventricular indices and NT-proBNP.
- Multivariate analyses confirmed LAD's independent association with PWV and 24-h PP.
Conclusions:
- Atrial fibrillation (AF) is proposed as a novel pathophysiological link between arterial stiffness and stroke.
- Findings highlight cardiac consequences of arterial stiffness, suggesting new AF prevention approaches.
Background:
Arterial stiffness is a strong predictor of cardiovascular events and particularly of stroke. A likely explanation is the development of atherosclerotic lesions at the carotid level, favored by increased local stiffness. Another possibility involves cardiac consequences of aortic stiffness and particularly left atrial dilatation with its subsequent risk of atrial fibrillation (AF) and cerebral embolism.
Aims:
The present study investigated the link between arterial stiffness, pulse pressure and left atrial size, a determinant of AF risk.
Methods:
Arterial stiffness was determined from pulse wave velocity (PWV) and pulse pressure (PP). Left atrial size was also measured. Several potential confounders were taken into account including indices of ventricular remodeling and diastolic function (estimated by NT-Pro brain natriuretic peptide (NT-proBNP) levels).
Results:
Three-hundred and ten hypertensive patients, aged 53 +/- 13 years, were included. Mean 24-h blood pressure (BP) was 154 +/- 20 over 93 +/- 13 mmHg. Significant relationships were found between left atrial diameter (LAD) and PWV (r=0.27, P<0.001) and between LAD and 24-h PP (r=0.32, P<0.001). LAD was also correlated significantly, although not always tightly, with left ventricular dimensions, geometry and NT-proBNP. In two different multivariate models, LAD remained significantly correlated with PWV or with 24-h PP, independently of classical determinants like age, gender, body mass index, ventricular remodeling (i.e. dimensions and geometry) and filling pressure.
Conclusion:
These results led us to propose AF as a new possible pathophysiological link between arterial stiffness and stroke. These results also emphasize the cardiac consequences of arterial stiffness which can fuel a new approach to AF prevention.
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