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Evaluation of the Relationship between Circadian Blood Pressure Variation and Left Atrial Function Using Strain
Chan Seok Park1, Gun-Hee An, Young-Woon Kim
1Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Insights
Non-dipper hypertensive patients exhibit enhanced left atrial function, specifically in reservoir and pump capacity, compared to dippers. These findings highlight the utility of strain imaging for early detection of subtle cardiac changes.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Diurnal blood pressure patterns influence cardiovascular health.
- Non-dipper hypertension is associated with altered left atrial function.
- Previous studies lacked detailed analysis of left atrial function in non-dippers using advanced imaging.
Purpose of the Study:
- To investigate left atrial function in never-treated hypertensive patients based on their diurnal blood pressure patterns.
- To compare left atrial function between dippers and non-dippers using tissue Doppler and strain imaging.
Main Methods:
- Forty never-treated hypertensive patients (age 30-80) were classified as dippers or non-dippers based on a <10% nocturnal blood pressure decrease.
- Left atrial strain, peak strain rates, and expansion index were measured using color Doppler tissue imaging.
Main Results:
- Non-dippers showed significantly increased left atrial expansion index, active emptying volume, and active emptying fraction.
- Mean peak left atrial strain, strain rate during reservoir, and contractile period were significantly higher in non-dippers compared to dippers.
- Statistical significance (p<0.05) was observed for all key parameters analyzed.
Conclusions:
- Color Doppler tissue imaging reveals exaggerated left atrial reservoir and booster pump function in non-dipper hypertensive patients.
- These imaging techniques are sensitive and simple for early detection of subclinical left atrial dysfunction.
- Findings suggest non-dipping is linked to compensatory hyperfunction of the left atrium in early hypertension.
Background:
Non-dippers were reported as showing different left atrial function, compared to dippers, but no study to date investigated the changes in the left atrial function according to the diurnal blood pressure pattern, using tissue Doppler and strain imaging.
Methods:
Forty never treated hypertensive patients between 30 and 80 years of age were enrolled in this study. Patients were classified as non-dippers when, during night time, they had a blood pressure decrease of less than 10%. Strain of the left atrium was measured during late systole, and peak strain rates of the left atrium were measured during systole, early and late diastolic periods.
Results:
The left atrial expansion index, left atrial active emptying volume and left atrial active emptying fraction were all significantly increased in non-dippers. They also had increased values of mean peak left atrial strain (dippers = 21.26 ± 4.23% vs. non-dippers = 24.91 ± 5.20%, p = 0.02), strain rate during reservoir (dippers = 1.29 ± 0.23 s(-1) vs. non-dippers =1.52 ± 0.27 s(-1), p = 0.01) and contractile period (dippers = -1.38 ± 0.24 s(-1) vs. non-dippers = -1.68 ± 0.32 s(-1), p < 0.01).
Conclusion:
Strain and strain rate acquired from color Doppler tissue imaging demonstrate exaggerated reservoir and booster pump function in never-treated, non-dipper hypertensive patients. These methods are simple and sensitive for the early detection of subtle changes in the left atrial function.
