Clinical Investigation
Ventricular and Atrial Mechanics
Early Detection of Left Atrial Strain Abnormalities by Speckle-Tracking in Hypertensive and Diabetic Patients with Normal Left Atrial Size

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Background

Systemic hypertension and type 2 diabetes mellitus are associated with impaired left atrial (LA) function, but whether LA functional abnormalities also occur in patients with hypertension and diabetes who have normal LA sizes is unknown. The aim of this study was to explore LA strain using speckle-tracking echocardiography in patients with hypertension or diabetes and normal LA size.

Methods

LA strain was studied by speckle-tracking echocardiography in 155 patients with hypertension or diabetes with LA volume indexes < 28 mL/m2 (83 with hypertension, 34 with diabetes, and 38 with both diabetes and hypertension) and 36 age-matched controls. The following indexes were measured: peak atrial longitudinal strain, time to peak atrial longitudinal strain, atrial longitudinal strain during early diastole and late diastole, and peak LA strain rate during ventricular systole, early diastole, and late diastole.

Results

Peak atrial longitudinal strain was lower in patients with hypertension (29.0 ± 6.5%) and those with diabetes (24.7 ± 6.4%) than in controls (39.6 ± 7.8%) and further reduced in patients with diabetes and hypertension (18.3 ± 5.0%) (P < .0001). Similar results were found for atrial longitudinal strain during early diastole, atrial longitudinal strain during late diastole, and peak LA strain rate during ventricular systole and early diastole (P < .0001 for all). An inverse trend was found for time to peak atrial longitudinal strain, whereas no differences in peak LA strain rate during late diastole were observed. Two-way analysis of variance showed no interactions between hypertension and diabetes. In multivariate analyses, hypertension and diabetes were both independently associated with decreases in all LA strain and strain rate indexes, with the exception of peak LA strain rate during late diastole.

Conclusions

LA deformation mechanics are impaired in patients with hypertension or diabetes with normal LA size. The coexistence of both conditions further impairs LA performance in an additive fashion. Speckle-tracking echocardiography may be considered a promising tool for the early detection of LA strain abnormalities in these patients.

Section snippets

Study Population

Asymptomatic patients affected by arterial hypertension and/or type 2 diabetes mellitus, consecutively enrolled in our laboratory of echocardiography between June 2009 and September 2010, were considered for this study. For inclusion in the study population, patients needed to have echocardiographic evidence of normal LA size, defined as LA volume indexed to body surface area < 28 mL/m2,25 and no symptoms of suspected cardiac origin. According to current European Society of Hypertension and

General Characteristics

In the overall study population, 14 subjects (nine patients and five controls) were excluded during offline strain analysis because of the impossibility of obtaining adequate tracking quality in more than three LA segments. Among a total of 2,292 segments analyzed in the remaining 155 patients (patients with hypertension but not diabetes, n = 83; patients with diabetes and normal blood pressure, n = 34; patients with diabetes and hypertension, n = 38) and 36 controls, adequate tracking was

Main Findings

In this study, we explored LA function by STE in patients with hypertension or diabetes and echocardiographic evidence of normal LA size. Our findings suggest that (1) LA deformation dynamics are impaired in these patients in comparison with age-matched and gender-matched controls, (2) the magnitude of this impairment is further increased in subjects with coexisting hypertension and diabetes, and (3) the association of hypertension and diabetes with LA strain abnormalities is independent of

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