Left atrial reservoir strain in hypertensive heart failure with preserved ejection fraction

Background

Hypertension is a leading cause and a major risk factor for heart failure with preserved ejection fraction(HFpEF). There are a number of studies that have shown both diagnostic and prognostic role of left atrial reservoir strain(LASr) in HFpEF.

Purpose

This study aimed to investigate the prognostic value of LASr for the clinical management of patients with hypertensive HFpEF receiving cardiovascular pharmacotherapy.

Methods

We examined a total of 96 patients(52 males, 44 females, mean age 55±8 years) diagnosed with both hypertension and HFpEF. Of these patients, 61 (63.54%) were current smokers, and 55(57.29%) had diagnosed dyslipidaemias(see Table 1). There were no other concurrent cardiovascular diseases reported in the cohort.

All patients received guideline-directed medical therapy. Comprehensive clinical assessments included 12-lead electrocardiography, routine blood tests, and transthoracic echocardiography using GE Vivid E95 equipment. Based on the LASr parameter, the patients were subsequently divided into two distinct groups:

Group A: Patients with an LASr<24%,

Group B: Patients with an LASr≥24%.

Results

The primary endpoint of the study was the occurrence of acute cardiovascular events(acute coronary syndrome, acute HF, paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, ventricular extrasystole, hypertensive crisis) at 18 months follow-up. A total of 96 patients were divided into two groups based on LASr measurements: Group A(n=62, LASr<24%), see figure 1 and Group B(n=34, LASr≥24%). All patients had their blood pressure measured before the echocardiographic study, ensuring all readings were below 140 mm Hg at the time of examination. The results showed that 14 out of 62 cases(22.58%) in Group A and 3 out of 34 cases(8.82%) in Group B experienced acute cardiovascular events, a statistically significant difference, p<0.02(see Table 2).

Conclusion

Reduced LASr is associated with frequent acute cardiovascular events in hypertensive HFpEF, and therefore, it may be a strong prognostic marker for the management of these patients.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.