REDUCED LEFT ATRIAL FUNCTION AND NORMAL EJECTION FRACTION IN HYPERTENSIVE PATIENTS WITH DYSPNOEA

Abstracts 13th Asia Pacific Congress of Doppler Echocardiography, Brisbane, 17–19 May, 2009

quantitative measurement of LA strain and strain rate (SR). Purpose: The aim of this study was to assess the LA function in PAF patients by 2DS. Methods: Echocardiographic evaluation including 2DS and tissue Doppler imaging was performed in 20 patients with PAF (mean age, 58 ± 10 years) and 73 age-matched healthy subjects (N; mean age, 56 ± 12 years) from apical four-chamber view and analyzed off-line. Longitudinal peak SR and strains during systole (LA-SRs and LA-Ss) and atrial systole (LA-SRa and LA-Sa) were measured at both septal and lateral walls of basal and mid-LA segments using 2DS, and data were averaged. Results: The PAF group had reduced LA reservoir and booster functions compared with N group, as shown by lower LA-SRs (1.9 ± 0.5 s−1 vs. 2.3 ± 0.6 s−1 , p < 0.01), LA-Ss (36 ± 11% vs. 46 ± 12%, p < 0.01), LA-SRa (−1.7 ± 0.4 s−1 vs. −2.3 ± 0.7 s−1 , p < 0.001), and LA-Sa (11 ± 4% vs. 16 ± 6%, p < 0.01), but there were no significant differences in LA volume (36 ± 13 ml/m2 vs. 33 ± 8 ml/m2 , p = NS), peak A wave velocity (68 ± 14 cm/s vs. 63 ± 18 cm/s, p = NS) and late diastolic mitral annular velocity (8.8 ± 2.4 cm/s vs. 8.9 ± 1.6 cm/s, p = NS). Conclusions: Passive stretching and active contraction of LA wall may be impaired in PAF patients in whom LA mechanical function and LA size are comparable to healthy subjects. 2DS is useful for detecting LA dysfunction in patients with PAF. doi:10.1016/j.hlc.2009.03.047 REDUCED LEFT ATRIAL FUNCTION AND NORMAL EJECTION FRACTION IN HYPERTENSIVE PATIENTS WITH DYSPNOEA Y.T. Tan, F. Wenzelburger 1 , E. Lee 2 , G. Heatlie 2 , K. Patel 1 , F. Leyva 1 , M. Frenneaux 1 , J.E. Sanderson 1 1 University

of Birmingham, Birmingham, United Kingdom Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom

2 University

Background: Hypertension and atrial fibrillation is common in patients with heart failure and normal ejection

21

Table 1. Patients (ml/m2 )

LAVI LVMI (g/m2 ) Am rest (cm/s) Am exercise (cm/s) LAFRI

31.6 92.6 6.9 8.1 0.98

± ± ± ± ±

9.8 34.4 1.6 1.7 1.44

Controls 23.9 77.9 7.8 10.0 1.92

± ± ± ± ±

8.7 19.3 1.7 2.3 1.47

p-Values 0.002 0.040 0.033 <0.001 0.033

fraction (HFNEF). Little is known about the atrial function of these patients. We hypothesize that hypertensive HFNEF patients have reduced atrial function particularly on exercise. Methods: 40 HFNEF patients with hypertension and sinus rhythm (72 ± 7 years, 30 female), and 25 age-matched healthy controls (69 ± 7 years, 19 female) were recruited. Rest and submaximal supine exercise echocardiography was performed and images were analysed off-line. Rest and exercise early (Em) and late diastolic myocardial velocities (Am) were assessed by Colour Tissue Doppler Imaging from the septal and lateral mitral annulus. The atrial functional reserve index (LAFRI) was calculated: (Am on exercise − Am at rest) × [1 − (1/Am at rest)]. Left atrial volume index (LAVI) and left ventricular mass index (LVMI) were derived from M-Mode. Results: Am was significantly reduced at rest and more so on exercise resulting in a significantly lower LAFRI in patients compared to controls. LAVI and LVMI were significantly higher in patients (Table 1). Am on exercise has a negative correlation with LAVI (r = −0.317, p = 0.006), LVMI (r = −0.351, p = 0.004) and E/Em on exercise (r = −0.540, p < 0.001). Conclusion: LA function is reduced in hypertensive HFNEF patients in sinus rhythm. LA functional reserve is reduced with increased LAVI and mean LA pressure as measured by E/Em. LA function plays an important role in late LV filling particularly when filling time is shortened on exercise. Progressive rise in mean LA pressure and change in LA dimension lead to impaired LA function which is more apparent on exercise. doi:10.1016/j.hlc.2009.03.048

ABSTRACTS

Heart, Lung and Circulation