Dilatation of the left atrium (LA) is usually found in high blood pressure without any valve damage. This dilatation is one of the prognostic markers and may be a reflection of left ventricular diastolic dysfunction. It can be used as one of the factors of morbi cardiovascular mortality. Diastolic dysfunction is acknowledged to be the predominant pathophysiological mechanism in patients with heart failure with preserved ejection fraction.
This work consists in carrying out in a series of 200 hypertensive patients (aged 25 to 75 years) an echocardiographic study, including the LVEF, the calculation of the indexed left ventricular mass as well as the relative parietal thickness, the calculation of the volume of the left atrium and the analysis of the diastolic function and finally the study of the longitudinal deformation of the LV. Excluded from this study were patients with secondary hypertension, leaky or stenotic valve disease, arrhythmia, history of coronary insufficiency.
Of the 200 hypertensive patients, 28 patients had a high LA volume, of which 27 patients had high filling pressures. Of the 28 patients with high LA volume 18 patients (64.2%) had low GLS. Patients with high LA volume are twice as likely to have low GLS as other patients. There is a statistically very significant relationship between lower GLS, increased left atrium volume, and increased left ventricular filling pressures in hypertensive patients. These results suggest that the increase in filling pressures is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with achievement of longitudinal systolic and diastolic dysfunction (Table 1).
Discussion and conclusion
The evaluation of LA size and function provides a powerful and dynamic morphophysiological marker of cardiovascular disease status that can be used longitudinally to quantify the extent of structural and functional remodeling.
Le texte complet de cet article est disponible en PDF.
Publié par Elsevier Masson SAS.