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PP.22.06: LEFT ATRIAL FUNCTION IN HYPERTENSIVE PATIENTS WITH IMPARED DIASTOLIC FILLING

Objective: All the volumetric modifications of the left atrium (LA), during cardiac cycle, are involved in hypertensive damage. Because the LA may become less spherical as it remodels, LA volume is proposed as a better index of LA remodeling. Design and method: In our study we used LA volume changes by meanings of two-dimensional echocardiography to investigate its function in hypertensive patients with left ventricle diastolic dysfunction (DD). Fourty-five hypertensive patients (20 men, 25 women; mean age 54,2 ± 4,0 years) with echocardiographically determined DD and 15 healthy volunteers (8 men, 7 women; mean age 45 ± 5 years) were included in the study. Mitral flow E/A ratio, Doppler indexes- velocities E, A, E/A, VTI E,VTI A, isovolumetric relaxation time (IVRT), and deceleration time (DT) of E wave were used for determination of the DD. We measured LA maximal and minimal volumes (Vmax,min), emptying volume (EV) and normalized them to body surface area: iLAVmax, iLAVmin. Following LA function parameters were calculated: LA work, iEV, emptying fraction (EF), LA emptying index (EI). LA enlargement was defined by criteria – iLAV > 22 ml/m2. Results: 28 patients had DD type – E < A, 14 patients had pseudonormal mitral flow pattern, and 3 had normal mitral flow pattern. Patients with DD type E < A had enlared LA (92%) by the LA max (P < 0.01 vs control, P > 0.05 vs pseudomitral flow), but its function was greater - significant difference in LA work, EI, EF (P < 0.05 vs pseudomitral flow). Also in this group there were positive correlation links between LA Vmax, EV and LVMI (r = 0,40, p < 0,03, r = 0,38, p < 0,01, respectively). Positive correlations between Doppler index VTI A and LA Vmax, EV (r = 0,31, p < 0,03, r = 0,33, p < 0,02) confirmed significant LA input in left ventricular diastolic filling. Patients with pseudonormal pattern of mitral flow had also enlarged LA in 86% (P < 0.01 vs control), but its function was impared (decreased emptying index and LA work). Conclusions: Hypertensive patients with LV diastolic dysfunction mostly had enlarged LA. Patients with pseudonormal pattern diastolic dysfunction had reduced filling of LA content to the left ventricle.