Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation

BACKGROUND: To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance. METHODS: LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%). RESULTS: Compared with controls, PALS(res), PALS(cond) and PALSR(cond) were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALS(pump), PALSR(pump) and TpS(pump)-SD% between them (all P > 0.05). PALS(pump), PALSR(pump) and PALSR(res) were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSR(pump) was further depressed in patients with both hypertension and PAF (P = 0.029). PALSR(cond) ≤ 1.475 s(− 1) combined with TpS(pump)-SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALS(pump) ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m(2) was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF. CONCLUSIONS: The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.