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A Practical Predictor for Identifying Reverse-Dipper Blood Pressure Patterns: Left Atrial Coupling Index
Ayca Arslan1, Dogan Ilıs2, Inanc Artac2
1Department of Cardiology, M.D. Kafkas University School of Medicine, Kars, Turkey. hivda.arslan@hotmail.com.
Insights
The novel Left Atrial Coupling Index (LACI) effectively predicts the reverse-dipper blood pressure (BP) pattern in hypertension patients. This echocardiographic measure is a more robust predictor than traditional markers, aiding in cardiovascular risk assessment.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Hypertension frequently causes myocardial abnormalities.
- The reverse-dipper blood pressure (BP) pattern is linked to adverse cardiovascular outcomes and subclinical heart damage.
- The Left Atrial Coupling Index (LACI) is a new echocardiographic tool for assessing cardiac function.
Purpose of the Study:
- To evaluate the Left Atrial Coupling Index (LACI) as a predictor for the reverse-dipper BP pattern in hypertensive individuals.
Main Methods:
- 404 hypertensive patients were enrolled, undergoing 24-hour ambulatory BP monitoring.
- Patients were categorized into dipper, non-dipper, and reverse-dipper groups based on nocturnal BP.
- Echocardiography was performed, and LACI was calculated for all participants.
Main Results:
- The reverse-dipper BP pattern was identified in 26% of patients.
- Reverse-dipper patients showed higher LACI, mitral E/A, E/Em, and left atrial volume index (LAVI).
- LACI, LAVI, and Am lateral mitral value independently predicted the reverse-dipper pattern; LACI outperformed LAVI.
Conclusions:
- The easily measured LACI is a superior echocardiographic predictor of the reverse-dipper BP pattern.
- LACI offers a more robust assessment compared to conventional echocardiographic markers for this hypertension subtype.
Introduction:
Hypertension is a common and persistent disorder and mostly causes myocardial structural and functional abnormalities. As a subtype pattern of HT, the reverse-dipper blood pressure (BP) is associated with worse cardiovascular outcomes and early-phase subclinical myocardial damage compared to other patterns. The Left Atrial Coupling Index (LACI) is a novel echocardiographic parameter developed to assess the mechanical function.
Aim:
The aim of this study was to investigate the role of the LACI in predicting the reverse-dipper BP pattern in patients with hypertension.
Methods:
A total of 404 hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring were prospectively enrolled. Patients were classified into dipper, non-dipper, and reverse-dipper groups based on their nocturnal BP profiles. Comprehensive echocardiographic evaluations were performed, and LACI was calculated for each patient.
Results:
A reverse-dipper BP pattern was observed in 26%(n = 105) of the 404 patients. Those with a reverse-dipper BP pattern exhibited higher mitral E/A ratio, E/Em means, left atrial volume index (LAVI), and LACI, along with lower Em septal, Am lateral mitral, and Am septal values. LACI (OR:3.837, 95% CI: 2.620-5.620, p < 0.001), LAVI, and Am lateral mitral value were found to be independent predictors of the reverse-dipper BP pattern. ROC curve comparison demonstrated that LACI was a better predictor of the reverse-dipper BP pattern than LAVI.
Conclusions:
Our study demonstrates that LACI, an easily accessible echocardiographic parameter, is a more robust predictor of the reverse-dipper BP pattern compared to traditional echocardiographic markers.
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01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:17Measurement of Blood Pressure
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.