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Comparison of the left atrial appendage flow velocities between patients with dipper versus nondipper hypertension
1Mus Sifa Hospital, Department of Cardiology, Mus, Turkey.
Insights
Nondipper hypertension (NDH) patients exhibit significantly reduced left atrial appendage (LAA) flow velocities compared to dipper hypertension (DH) patients and controls. This suggests a need for aggressive treatment in NDH to maintain LAA function.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Physiology
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Ambulatory blood pressure monitoring differentiates between dipper and nondipper hypertension.
- Left atrial appendage (LAA) function plays a role in preventing thromboembolic events.
Purpose of the Study:
- To compare left atrial appendage (LAA) flow velocities in patients with nondipper hypertension (NDH) versus dipper hypertension (DH) and normal subjects.
- To investigate the impact of hypertension dipping status on LAA hemodynamics.
Main Methods:
- Cross-sectional study involving 23 NDH patients, 25 DH patients, and 25 controls.
- Echocardiography and transesophageal echocardiography were used for LAA visualization.
- Pulsed-wave Doppler assessed LAA filling and ejection velocities.
Main Results:
- Mean LAA ejection velocity was significantly lower in NDH (47.7 cm/sec) compared to DH (66.3 cm/sec) and controls (81.7 cm/sec) (P < 0.001).
- Mean LAA filling velocity was also significantly lower in NDH (41.7 cm/sec) versus DH (58.8 cm/sec) and controls (67.2 cm/sec) (P < 0.001).
Conclusions:
- Nondipper hypertension is associated with impaired LAA filling and ejection flow rates.
- Consideration of more aggressive treatment strategies for NDH patients is warranted.
- Maintaining LAA function may be crucial in preventing complications related to LAA dysfunction.
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.
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