Changes in left atrial dimension and function and left ventricular geometry in newly diagnosed untreated hypertensive subjects

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Abstract

Background

It is known that a spectrum of changes in structure, size and function of the different chambers of the heart occur in individuals with hypertension. The earliest changes and the sequence of these changes are still being studied.

Aims

The present study aimed to assess early changes in the left atrial size and function in hypertension, and its relationship with left ventricular geometry and other factors that may influence left atrial size.

Methods

One hundred consecutive subjects who were newly diagnosed with hypertension and 50 apparently normal individuals were recruited into the study. Standard M-mode, two-dimensional and Doppler echocardiography were performed. The endocardial border of the left atrium was traced to obtain the atrial area and left atrial volumes and emptying fractions were derived from measured areas.

Results

The hypertensive patients and the controls were comparable by age, sex and body mass index. Thirty-seven (37%) of the hypertensive subject had increased left ventricular mass versus eight subjects (16%) in the normal controls. The patients with hypertension had a higher linear left atrial dimension (3.5 ± 0.48 cm versus 3.1 ± 0.47 cm, P < 0.0001), longer pre-atrial contraction length (3.8 ± 0.56 cm versus 3.6 ± 0.45 cm; P = 0.02) and higher peak late mitral inflow velocity (0.64 ± 0.19 m/s versus 0.56 ± 0.15 m/s; P = 0.010).

Conclusions

Changes in the geometry of the left ventricle occur early in hypertension and precede deterioration in left ventricular systolic function. The corresponding left atrial changes are marginal and are indicative of increased left atrial length and accentuated atrial systolic function.

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