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Comparison of left atrial mechanical function in nondipper versus dipper hypertensive patients: a speckle tracking
Göksel Açar1, Mustafa Bulut, Kursat Arslan
1Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital, Istanbul, Turkey. gokselacar81@hotmail.com
Insights
Hypertension nondippers show impaired left atrial (LA) function and adverse cardiac remodeling. This study highlights the cardiovascular risks associated with nondipping status in treated hypertensive patients.
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- Nondipping status in hypertension is linked to increased cardiovascular risks.
- Understanding the impact of hypertension dipping status on cardiac function is crucial for risk stratification.
Purpose of the Study:
- To investigate the effects of dipper and nondipper hypertension status on left atrial (LA) myocardial function.
- To assess longitudinal systolic and diastolic functions using 2D speckle-tracking echocardiography.
Main Methods:
- Included 78 treated hypertensive outpatients with at least 1 year of antihypertensive therapy.
- Classified patients into dipper and nondipper groups based on 24-hour ambulatory blood pressure monitoring.
- Analyzed global longitudinal LA strain and strain rate using 2D speckle imaging.
Main Results:
- Nondippers exhibited higher LA volume index, LV wall thickness, mass index, and filling pressure (E/E').
- Nondippers showed significantly lower systolic tissue velocity (S') and impaired LA strain/strain rate.
- LA mechanical dysfunction correlated with LV mass, filling pressure, and regional contractility.
Conclusions:
- Nondipping in treated hypertensive patients is associated with adverse cardiac remodeling.
- Impaired left atrial mechanical function is evident in nondippers.
- Further research is needed to confirm the prognostic value of these echocardiographic findings.
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.