Assessment Of Left Atrial Fuction And Structure In Patients With Hypertension By Doppler Echocardiography

Background: Hypertension is one of the most common worldwide diseases afflicting humans'health. Because of the associated morbidity, mortality and the cost to society, hypertension is an important public health challenge. Cardiac involvement in hypertension manifests as LVH, left atrial enlargement, aortic root dilatation, atrial and ventricular arrhythmias, systolic and diastolic heart failure, and ischemic heart disease.The exact determinants of left ventricular diastolic dysfunction have not been well studied.Objective: The objective of this study is to explore left atrial structure and function changes in 70 cases of essential hypertension by 2-DE, M-mode and tissue Doppler imaging(TDI) echocardiography.Methods: 70 hypertensive patients and 30 control subjects were studied. According to left ventricular mass index, patients with hypertension were divided into normal geometry group(n=38) and hypertrophy group(n=32). Left ventricular mass index higher than 143g/m2(male) or 102 g/m2(female) was defined as left ventricular hypertrophy. Ultrasonography imager was used to measure the internal diameter of left atrium(LAD), interventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), left ventricular ejection fraction(LVEF), LA conduit volume(LACV), LA stroke volume(LASV), LA reservoir volume(LARV), left ventricular mass index(LVMI), left atrial volume(LAV), E/A ratio, peak atrial tissue velocity(E'/A'ratio), rest heart rate(RHR) and Tei index.Results: LAD significantly enlarged in hypertension and normal LVMI patients compared with that of the control group. BMI,LVEDd,IVST,LVMW,LVMI, E/A,E'/A',Tei-1,Tei-2,LAEF,LASV,LACV,LARV were significantly different between hypertensive group and normal group. Multivariate analysis showed that LAD was correlated with LVMI(r=0.382, P<0.01),LVMW(r=0.258, P<0.05),BMI(r=0.312, P<0.01),SBP(r=0.301, P<0.01),pulse pressure(r=0.249, P<0.01),E'/A'(r=-0.241, P<0.05),Tei-2(r=0.314, P<0.01)and duration of hypertension(r=0.398, P<0.01).Conclusion: The LAD enlarge before the left ventricular hypertrophy. LAD enlargement might be a earlier marker of the damage of myocardium in the development of hypertension, and has more clinical significance. During early period of hypertension impairment cardiac function was diastolic function, and it took place before systolic function. Left atrial function can indicate the echocardiographic changes of the left ventricular abnormal diastolic function in the earlier stage. To evaluate the structure and function of left atrial with Echocardiography is noninvasive, easy and accurately.