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Comparison of tissue Doppler dynamics with Doppler flow in evaluating left atrial appendage function by
Erhan Tenekecioğlu1, Aziz Karabulut, Mustafa Yilmaz
1Department of Cardiology, Batman Dünya Hospital, Batman, Turkey. erhantenekecioglu@yahoo.com
Insights
High blood pressure impairs left atrial appendage (LAA) function even in early hypertension stages. Tissue Doppler imaging detects LAA dysfunction early, highlighting the need for BP control to prevent cardiovascular risks.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Increased blood pressure (BP) is a significant risk factor for cardiovascular mortality and morbidity.
- Early detection of cardiovascular changes is crucial for timely intervention and prevention of adverse outcomes.
Purpose of the Study:
- To investigate the impact of elevated blood pressure on left atrial appendage (LAA) function in early stages of hypertension.
- To evaluate the utility of Tissue Doppler Imaging (TDI) in detecting LAA functional impairments in hypertensive patients.
Main Methods:
- Prospective transesophageal echocardiography (TEE) in 120 patients with elevated BP and 58 normotensive controls.
- Patients categorized into prehypertensive, stage-1 hypertensive, and stage-2 hypertensive groups based on JNC VII criteria.
- Assessment of LAA late-emptying velocities (LAAEV), LAA late-contracting velocity (LAA TDI-D2), and LAA maximal areas.
Main Results:
- LAA late-emptying velocities were reduced in stage-2 hypertensives.
- LAA late-contracting velocity was significantly reduced across all hypertensive groups (prehypertension, stage-1, stage-2) compared to controls.
- Increased LAA maximal areas were observed in stage-2 hypertensives; spontaneous echocardiographic contrast and left atrial thrombi were noted in advanced stages.
Conclusions:
- Elevated afterload in hypertension impairs left atrial and LAA function, detectable even in prehypertension.
- Tissue Doppler Imaging (TDI) is more sensitive than conventional Doppler for detecting early LAA functional impairment.
- Maintaining normal BP levels is essential to prevent LAA dysfunction and associated cardiovascular risks.
Abstract:
Increased blood pressure (BP) is associated with an increase in cardiovascular mortality and morbidity. We aimed to analyze the effect of increased BP onto the function of left atrial appendage (LAA) in early stages of hypertension. Transesophageal echocardiography (TEE) was prospectively performed to assess LAA functions in 120 patients with increased BP, and in 58 normotensive subjects without cardiovascular disease. Patients with increased BP were divided according to Joint National Committee VII (JNC VII) report: prehypertensive, stage-1 hypertensive and stage-2 hypertensive patients. During TEE, LAA late-emptying velocities (LAAEV) were significantly reduced only in stage-2 hypertensives as compared with control group (P < 0.001). In contrast, LAA late-contracting velocity (LAA TDI-D2) was significantly reduced in prehypertensive,stage-1 hypertensive and stage-2 hypertensive patients, when compared with control group (P < 0.05, P < 0.001, and P < 0.001, respectively). The LAA maximal areas were increased significantly only in stage-2 hypertensive patients when compared with control group (P < 0.05). During TEE, left atrial spontaneous echocardiographic contrast was found in 2 of 36 patients in prehypertension group, in 7 of 40 patients in stage-1 hypertension group, and in 10 of 44 patients in stage-2 hypertension group. Left atrial thrombi were observed in 3 (6.8%) patients of stage-2 hypertension group. In conclusion, in patients with untreated prehypertension and hypertension, elevation of afterload imposed on left atrium involved both left atrium and LAA, resulting in impairment of the LAA function. Tissue Doppler imaging (TDI) enables the detection of this functional impairment in early stages of hypertension, even in prehypertensive phase, when compared with conventional Doppler flow measurement of the LAA. Even in prehypertensive phase, BP should be decreased to normal levels to prevent the LAA dysfunction.
