OS 27-04 PREDICTION OF LEFT VENTRICULAR DYSTOLIC DYSFUNCTION IN PATIENT WITH ARTERIAL HYPERTENSION.

OBJECTIVE: Arterial hypertension (HTN) causes left ventricular (LV) dysfunction even if ejection function (EF) remains preserved. The objective of this study was to assess whether complex LAFI (left atrium functional index) had additional value in definition and grading of diastolic dysfunction and compare with indices of atrial deformation - longitudinal strain.

DESIGN AND METHOD: Peak atrial longitudinal strain (PALS) was evaluated in 82 patients with systemic HTN and preserved EF (> = 55%) divided in 41 with diastolic dysfunction but no hypertrophy (HTNdd), and 41 with no diastolic dysfunction or hypertrophy (eHTN). Results were compared with those from 22 age- and gender-matched healthy controls.

RESULTS: Indexed LA area and LA volume were within the normal range and not different between the two groups and controls. eHTN group had reduced global PALS (33.23 ± 2.3 %, p < 0.01) and four-and two-chamber average PALS (36.12 ± 1.8 %, p < 0.01 for both). Similar abnormalities were seen in HTNdd but to a worse degree (P < 0.001 for both 28.19 ± 2.3). LV EF was not different between the eHTN and HTNdd groups compared to controls. LV E/e' ratio was the strongest predictor of reduced global PALS in both eHTN and HTNdd groups. LAFI was reduced significantly in pts with HTH and LV diastolic dysfunction (p < 0.05) and related to the degree of dysfunction (p < 0.01, r = 0.46). The best cut off for LAFI was below 0.35 cm/m2. In pts with restrictive pattern of mitral flow, LAFI was below 0.15 cm/m2. Longitudinal strain was significantly decreased in pts with severe LVH.

CONCLUSIONS: Asymptomatic HTN patients with preserved LVEF have compromised LA strain despite normal cavity size, consistent with preclinical LA myocardial dysfunction. LAFI and PALS are very sensitive parameters for assessing of LA function and potent predictors for estimate the LV diastolic dysfunction in hypertensive patients.