P737Left atrial function by speckle-tracking echocardiography in acute hypertensive edema

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Acute hypertensive pulmonary edema (AHPE) is associated with longitudinal left ventricular (LV) dysfunction (data reported previously). We hereby report the acute changes in left atrial (LA) function during AHPE.Methods: 24 patients (71±10 yrs, 18 women) with acute dyspnoea within the preceding 8h, pulmonary congestion, sinus rhythm, systolic BP≥160mmHg, and adequate LA images were assessed at admission, and after 48-92h; significant valvular disease and acute myocardial infarction were excluded. LA function was evaluated by conventional and speckle-tracking echo from the apical 4C and 2C views. LA volumes at MVC, MVO, and at the onset of P-wave, and also mean global LA strain, strain rate, and derived times were measured. Active LA function was assessed by active EF (EFa=prePvol-MVCvol)/prePvol), mean negative global strain at maximal atrial contraction (MSA-), and time from P onset to peak (MTSA-); passive function from passive EF (EFp=MVOvol-prePvol)/MVOvol), mean positive peak global strain (MSA+), and time from R-wave to peak (MTSA+), and also from mean early negative global strain rate in early LV diastole (MSRE); reservoir function from the sum of MSA- and MSA+ (MSASUM), mean positive global strain rate at the beginning of LV systole (MSR+), time from P to peak (MTSR+), and expansion index (EFr=MVOvol–MVCvol)/MVCvol). LV systolic function was assessed by EF, mean longitudinal strain and strain rate; diastolic function by E/Ea and E/Vp ratios.Results: There were no changes in global systolic and diastolic LV function. Active LA function was not changed during AHPE, however LA relaxation (MSA+) was significantly lower, and reservoir function was shorter (MTSR+) during AHPE. MSA- correlated significantly (r=0.4-0.6) with LV longitudinal dysfunction (strain and strain rate). LA relaxation (MSA+) correlated with EF, LVstrain, and LV end-diastolic pressure (E/Vp).Conclusion: LA relaxation function is lower during AHPE, which correlates with longitudinal LV dysfunction. LA active function was not changed, probably because of similar preload stretch and atrial afterload (E/Ea, E/Vp).

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