Relationship between left atrial volume changes and endothelial dysfunction in patients with systemic hypertension

BaturGonenc Kanar., HaticeSelen Kanar., Tarik Kivrak and Murat Sünbül

Purpose: The aim of this study was to evaluate the association between left atrial (LA) volume changes measured by three-dimensional echocardiographic (RT3DE) and endothelial dysfunction (ED) in patients with systemic hypertension (HT).
Methods: This study included 66 consecutive systemic hypertensive patients (62.0±10.2 years, 24 males) and 31 healthy control participants (61.4±9.1 years, 14 males). All participants underwent two and three-dimensional echocardiographic measurements. Brachial artery endothelial measurements and spectral-domain optical coherence tomography (SD-OCT) measurements were also performed to assess respectively ED and hypertensive retinochoroidal changes. The systemic hypertensive patients were divided into two groups according to ED which is determined by brachial artery endothelial measurements.
Results: The three groups did not differ with regards to age, sex or metabolic profile. In RT3DE measurements, systemic hypertensive patients had elevated left atrial phasic volumes [Left atrium (LA) maximal volume index, LA minimal volume index, LA preatrial contraction volume index, p < 0.001] and worse left atrial mechanical functions (reservoir, conduit, and atrial contraction p<0.001). In the logistic regression analysis, the LA total stroke volume index (86% sensitivity and 93% specificity, area under the curve: 0.96, p<0.001) and mean choroidal thickness (86% sensitivity and 82% specificity, area under the curve: 0.89, p<0.001) were independent predictors of ED in patients with systemic HT.
Conclusion: Patients with systemic HT had increased LA volumes, decrease retinochoroidal thickness, impaired left atrial phasic functions and also endothelial functions. Moreover, RT3DE identified early volume and functional LA changes in these patients better than conventional echocardiography. Assessment of hypertensive patients with RT3DE atrial volume analysis may facilitate an early recognition of target organ damage (TOD).

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