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Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients

Journal of Human Hypertension volume 23, pages 743–750 (2009)Cite this article

Abstract

Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (<70 years old) essential hypertensive patients.We evaluated cardiac structure and function in 458 patients, 394 treated and untreated mild to moderate essential hypertensives patients (mean±s.d. age 48.4±11.1 years) with no associated clinical condition and 64 normotensive control participants (age 45.7±12.8 years; P=0.12). A multivariate analysis was performed to calculate the relative weight of each of the variables considered able to predict LAV. The LAV index (LAVi) was significantly increased in the essential hypertensive group vs the control group and was significantly dependent on blood pressure levels (SBP and DBP, P<0.05 for both) and body mass index (BMI) (P<0.0001). Considering the left ventricular (LV) variables, the LV mass index (LVMI) (R2=0.19, P<0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients.

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References

  1. Wolf PA . An overview of the epidemiology of stroke. Stroke 1990; 21: II4–II6.

    Article  CAS  Google Scholar 

  2. Abbott RD, Curb JD, Rodriguez BL, Masaki KH, Popper JS, Ross GW et al. Age-related changes in risk factor effects on the incidence of thromboembolic and hemorrhagic stroke. J Clin Epidemiol 2003; 56: 479–486.

    Article  Google Scholar 

  3. Bonow RO, Carabello BA, Kanu C, de Leon Jr AC, Faxon DP, Freed MD et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 2006; 114: e84–e231.

    Article  Google Scholar 

  4. Ganau A, Devereux RB, Pickering TG, Roman MJ, Schnall PL, Santucci S et al. Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension. Circulation 1990; 81: 25–36.

    Article  CAS  Google Scholar 

  5. Di Tullio MR, Sacco RL, Sciacca RR, Homma S . Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke 1999; 30: 2019–2024.

    Article  CAS  Google Scholar 

  6. Verdecchia P, Reboldi G, Gattobigio R, Bentivoglio M, Borgioni C, Angeli F et al. Atrial fibrillation in hypertension: predictors and outcome. Hypertension 2003; 41: 218–223.

    Article  CAS  Google Scholar 

  7. Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial. Hypertension 2007; 49: 311–316.

    Article  CAS  Google Scholar 

  8. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB . Risks for atrial fibrillation and congestive heart failure in patients ⩾65 years of age with abnormal left ventricular diastolic relaxation. Am J Cardiol 2004; 93: 54–58.

    Article  Google Scholar 

  9. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM . Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 2003; 41: 1036–1043.

    Article  Google Scholar 

  10. Gottdiener JS, Reda DJ, Williams DW, Materson BJ . Left atrial size in hypertensive men: influence of obesity, race and age. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. J Am Coll Cardiol 1997; 29: 651–658.

    Article  CAS  Google Scholar 

  11. Gerdts E, Oikarinen L, Palmieri V, Otterstad JE, Wachtell K, Boman K et al. Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Hypertension 2002; 39: 739–743.

    Article  CAS  Google Scholar 

  12. European Society of Hypertension. European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

    Article  Google Scholar 

  13. Sahn DJ, DeMaria A, Kisslo J, Weyman A . Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083.

    Article  CAS  Google Scholar 

  14. Devereux RB, Reichek N . Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613–618.

    Article  CAS  Google Scholar 

  15. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.

    Article  CAS  Google Scholar 

  16. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550–1558.

    Article  CAS  Google Scholar 

  17. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA . Recommendations for quantification of Doppler echocardiography: a report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 167–184.

    Article  Google Scholar 

  18. Garcia MJ, Thomas JD, Klein AL . New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865–875.

    Article  CAS  Google Scholar 

  19. Khouri SJ, Maly GT, Suh DD, Walsh TE . A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 2004; 17: 290–297.

    Article  Google Scholar 

  20. Schirmer H, Lunde P, Rasmussen K . Mitral flow derived Doppler indices of left ventricular diastolic function in a general population; the Tromso study. Eur Heart J 2000; 21: 1376–1386.

    Article  CAS  Google Scholar 

  21. Cuspidi C, Meani S, Fusi V, Valerio C, Catini E, Sala C et al. A Prevalence and correlates of left atrial enlargement in essential hypertension: role of ventricular geometry and the metabolic syndrome: the Evaluation of Target Organ Damage in Hypertension study. J Hypertens 2005; 23: 875–882.

    Article  CAS  Google Scholar 

  22. Cuspidi C, Meani S, Valerio C, Fusi V, Catini E, Sala C et al. Ambulatory blood pressure, target organ damage and left atrial size in never-treated essential hypertensive individuals. J Hypertens 2005; 23: 1589–1595.

    Article  CAS  Google Scholar 

  23. Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS . Atrial fibrillation and obesity—results of a meta-analysis. Am Heart J 2008; 155: 310–315.

    Article  Google Scholar 

  24. de Simone G, Devereux RB, Daniels SR, Mureddu G, Roman MJ, Kimball TR et al. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation 1997; 95: 1837–1843.

    Article  CAS  Google Scholar 

  25. Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL . Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable? J Am Coll Cardiol 2002; 40: 1630–1635.

    Article  Google Scholar 

  26. Cioffi G, Mureddu GF, Stefenelli C, de Simone G . Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension. J Hypertens 2004; 22: 1589–1596.

    Article  CAS  Google Scholar 

  27. Mineoi K, Shigematsu Y, Ochi T, Hiwada K . Left ventricular mass and atrial volume determined by cine magnetic resonance imaging in essential hypertension. Am J Hypertens 2000; 13: 1103–1109.

    Article  CAS  Google Scholar 

  28. Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA . Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons &gt; or =65 years of age (the cardiovascular health study). Am J Cardiol 2006; 97: 83–89.

    Article  Google Scholar 

  29. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006; 47: 2357–2363.

    Article  Google Scholar 

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Acknowledgements

We thank Dr Tracy Ann Williams for her contribution to the editing of the paper and the language revision. This study was supported by a grant from the REGIONE PIEMONTE 2006.

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Authors and Affiliations

  1. Department of Medicine and Experimental Oncology, Division of Internal Medicine, Hypertension Unit, University of Torino, Torino, Italy

    A Milan, M A Caserta, A Dematteis, D Naso, A Pertusio, C Magnino, E Puglisi, F Rabbia, P Mulatero & F Veglio

  2. Division of Cardiology, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA

    N G Pandian

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  1. A Milan
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Correspondence to A Milan.

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Milan, A., Caserta, M., Dematteis, A. et al. Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients. J Hum Hypertens 23, 743–750 (2009). https://doi.org/10.1038/jhh.2009.15

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