DOI: 10.4103/jcecho.jcecho_66_26 ISSN: 2211-4122

Left Atrial Filling Index in Hypertensive Patients with Preserved Ejection Fraction

Mohamed Fahmy El Noamany, Naglaa Fahim Ahmed, Mohamed Mohsen Abdel Fatah, Ashraf Abdelraouf Dawod, Suzy Salah Lasheen
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Context:

The left atrium (LA) is no longer viewed as a passive transport chamber but as a sensitive barometer that reflects LV filling pressures over time, so early impairment of atrial compliance and mechanics often precedes overt chamber enlargement or symptomatic heart failure.

Aim:

To evaluate the diagnostic value of the left atrial (LA) filling index (E/LA reservoir strain [LARS] ratio) and its correlation with brain natriuretic peptide (BNP) as a surrogate for left ventricle (LV) filling pressures in hypertensive patients with preserved ejection fraction (EF).

Methods:

A case-control study was conducted on 91 participants: Group I ( n = 35, hypertensive patients without left ventricular hypertrophy (LVH), Group II ( n = 36, hypertensive with LVH), and Group III ( n = 20, healthy controls). All participants underwent Two-dimensional-speckle tracking echocardiography using a GE Vivid E95 system to assess LA phasic mechanics. The LA filling index was calculated as E-wave velocity divided by LARS.

Results:

LA reservoir and conduit strain were significantly impaired in both hypertensive groups compared to controls ( P < 0.001). The LA filling index was significantly higher in hypertensive patients, particularly those with LVH ( P < 0.001). A significant positive correlation was found between the LA filling index and both the E/e’ ratio ( r = 0.420, P < 0.001) and BNP levels ( r = 0.378, P < 0.001).

Conclusion:

The E/LA strain ratio appears to be a promising, noninvasive marker for detecting subclinical atrial myopathy and elevated LV filling pressures in hypertensive heart disease, even before overt structural remodeling occurs.

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