J Cardiovasc Ultrasound.  2011 Dec;19(4):183-191. 10.4250/jcu.2011.19.4.183.

Evaluation of the Relationship between Circadian Blood Pressure Variation and Left Atrial Function Using Strain Imaging

• Park CS
• An GH
• Kim YW
• Park YJ
• Kim MJ
• Cho EJ
• Ihm SH
• Jung HO
• Kim HY
• Jeon HK
• Youn HJ
• Kim JH

• KMID: 1980380
• DOI: http://doi.org/10.4250/jcu.2011.19.4.183

Abstract

BACKGROUND
Non-dippers were reported as showing different left atrial function, compared to dippers, but no study to date investigated the changes in the left atrial function according to the diurnal blood pressure pattern, using tissue Doppler and strain imaging.
METHODS
Forty never treated hypertensive patients between 30 and 80 years of age were enrolled in this study. Patients were classified as non-dippers when, during night time, they had a blood pressure decrease of less than 10%. Strain of the left atrium was measured during late systole, and peak strain rates of the left atrium were measured during systole, early and late diastolic periods.
RESULTS
The left atrial expansion index, left atrial active emptying volume and left atrial active emptying fraction were all significantly increased in non-dippers. They also had increased values of mean peak left atrial strain (dippers = 21.26 +/- 4.23% vs. non-dippers = 24.91 +/- 5.20%, p = 0.02), strain rate during reservoir (dippers = 1.29 +/- 0.23 s-1 vs. non-dippers =1.52 +/- 0.27 s-1, p = 0.01) and contractile period (dippers = -1.38 +/- 0.24 s-1 vs. non-dippers = -1.68 +/- 0.32 s-1, p < 0.01).
CONCLUSION
Strain and strain rate acquired from color Doppler tissue imaging demonstrate exaggerated reservoir and booster pump function in never-treated, non-dipper hypertensive patients. These methods are simple and sensitive for the early detection of subtle changes in the left atrial function.

Keyword

Left atrium; Echocardiography; Strains; Hypertension; Circadian rhythm

MeSH Terms

Atrial Function, Left
Blood Pressure
Circadian Rhythm
Echocardiography
Heart Atria
Humans
Hypertension
Sprains and Strains
Systole

Figure

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  Fig. 1 A: Arrow indicates peak left atrial strain during the late systole. B: Arrows indicate peak left atrial strain rate during systole, early and late diastole.

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  Fig. 2 Bland-Altman analyses for intra- and inter-observer variability.

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