Left atrial stiffness: a novel marker of hypertension-mediated organ damage on the horizon?

Evaluation of the relationship between left atrial stiffness, left ventricular stiffness, and left atrioventricular coupling index in type 2 diabetes patients: a speckle tracking echocardiography study

Background

Cardiovascular complications are a leading cause of mortality and disability in individuals with diabetes mellitus (DM). Moreover, DM can directly impact the structure and function of cardiac muscle. We conducted a study to evaluate cardiac stiffness in DM patients in both the left atrium (LA) and left ventricle (LV), as well as to assess the impact of DM on the synchronization of the LA and LV, particularly within the Vietnamese population, utilizing speckle tracking echocardiography (STE).

Methods

We studied 111 research subjects divided into two groups comprising 52 patients with DM and 59 healthy individuals. All the subjects provided relevant clinical information, and echocardiography was performed to assess the indices of LA stiffness, LV stiffness, and left atrioventricular coupling index (LACI).

Results

Our study indicated that DM patients exhibited greater LA and LV stiffness than control patients. The LACI (%) in the DM group was also greater than that in the control group (17.12% ± 6.72% vs. 12.28% ± 3.96%, respectively; p < 0.001). The LACI was positively correlated with the LA and LV stiffness indices. Decreased levels of LV GLS, adjusted for age, sex, blood pressure, and BMI, have emerged as identified risk factors for DM.

Conclusions

LA stiffness, LV stiffness, and the LACI are greater in DM patients than in normal individuals.

Assessment of subclinical left atrial myocardial dysfunction in essential hypertension patients with normal left ventricle function by two-dimensional strain and volume-derived variables

PURPOSE

To investigate subclinical left atrial (LA) myocardial dysfunction in essential hypertension (EHT) patients by using volume-derived and two-dimensional strain.

METHODS

We enrolled in this study 51 normal subjects and 95 EHT patients. The LA volume-derived index was measured in apical 4- and 2-chamber views. LA strain and strain rate, reservoir, conduit, and booster pump functions were measured by two-dimensional speckle tracking echocardiography (STE).

RESULTS

LA ejection fraction (LAEF) and absolute strain-derived values were significantly lower in EHT patients than in controls. LAEF (total, passive), absolute values of LA strain (S-reservoir and S-conduit), and strain rate (Sr-reservoir and Sr-conduit) were significantly lower in EHT patients with left ventricular hypertrophy (LVH) than in patients without LVH and in controls. However, there were no significant difference in active LAEF or S-booster pump and Sr-booster pump functions between EHT patients without LVH and normal subjects. The areas under the curves of the combination of volume-derived values, LA strain, and strain rate were significantly higher than those of individual indices.

CONCLUSION

In our population, EHT patients showed impaired LA functions and greater stiffness than normal subjects. EHT patients with LVH showed greater impairment of LA reservoir and conduit functions than patients without LVH. EHT patients without LVH had normal LA booster pump function, which was impaired in patients with LVH. Volume-derived and 2D strain values could provide a sensitive and reproducible method for detecting subclinical LA myocardial dysfunction in EHT.