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Updated: Oct 17, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Effects of blood pressure and heart rate circadian rhythms on left atrial function
Yixiao Zhao1,2, Yan Liu1, Qiaobing Sun1
1Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning.
Insights
Abnormal blood pressure and heart rate circadian rhythms in hypertension are linked to impaired left atrial function. Specifically, increased left atrial stiffness correlates with night-time blood pressure and heart rate patterns.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Essential hypertension is a common condition characterized by elevated blood pressure.
- Circadian rhythms of blood pressure (BP) and heart rate (HR) play a crucial role in cardiovascular health.
- Left atrial function is increasingly recognized as an important indicator of cardiovascular status.
Purpose of the Study:
- To investigate the associations between circadian BP and HR rhythms and left atrial function in patients with essential hypertension.
- To identify predictors of increased left atrial stiffness in hypertensive individuals.
Main Methods:
- 237 essential hypertensive patients underwent 24-hour ambulatory BP and HR monitoring.
- Two-dimensional speckle tracking echocardiography (2DSTE) was used to assess left atrial reservoir, conduit, and booster strains and strain rates.
- Left atrial stiffness index (LASI) was calculated, and patients were grouped based on nocturnal BP dipping patterns.
Main Results:
- Patients with abnormal nocturnal BP dipping (reverse dippers) exhibited significantly higher LASI compared to dippers and non-dippers.
- Impaired left atrial reservoir (LAS-S) and conduit (LAS-E, LASR-E) functions were observed in reverse dippers.
- Multivariate analysis revealed that age, night-time systolic blood pressure (SBP), and nocturnal HR decline percentage were independent predictors of increased LASI.
Conclusions:
- Impaired left atrial reservoir and conduit functions are associated with abnormal circadian BP and HR rhythms in hypertension.
- Elevated left atrial stiffness is linked to specific night-time BP and HR patterns, highlighting the importance of circadian variations.
- These findings suggest that assessing left atrial function alongside circadian BP/HR patterns may offer valuable insights into cardiovascular risk in hypertension.
Objective:
We examined the associations among the circadian rhythms of blood pressure (BP), heart rate (HR) and left atrial function in essential hypertensive patients.
Methods:
The study included 237 essential hypertensive patients who completed 24-h ambulatory BP, HR monitoring and two-dimensional speckle tracking echocardiography (2DSTE). The strain and strain rate images were studied, and the following parameters were measured: left atrial reservoir strain and strain rate (LAS-S and LASR-S), left atrial conduit strain and strain rate (LAS-E and LASR-E), and left atrial booster strain and strain rate (LAS-A and LASR-A). The left atrial stiffness index (LASI) was identified as the ratio of E/e' to LAS-S. All participants were divided into three groups according to the percentage of nocturnal BP dipping (dippers, nondippers and reverse dippers).
Results:
The LASI was significantly higher in BP reverse dippers than in dippers and nondippers. LAS-S, LAS-E and LASR-E were significantly lower in BP reverse dippers than dippers and nondippers. Multivariate logistic regression analysis demonstrated that age, night-time mean SBP and the percentage of nocturnal HR decline were independently related to an increased LASI.
Conclusion:
Impairment of the left atrial reservoir and conduit functions was correlated with abnormal BP and HR circadian rhythms in hypertension. Increased left atrial stiffness was associated with night-time SBP and the percentage of nocturnal HR decline.
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