Atrial electromechanical abnormalities in hypertensive patients with diastolic dysfunction

• Published in: The Egyptian heart journal Vol. 66; no. 1; p. 16
• Main Author: Ali Abass, Mohamed Hussien
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-03-2014; SpringerOpen
• ISSN: 1110-2608; 2090-911X
• DOI: 10.1016/j.ehj.2013.12.045

It was to compare atrial electromechanical delays (AEMDs) by pulsed tissue Doppler echocardiography between hypertensive patients and healthy controls. It was used as a predictor for development of atrial arrhythmias as proved by other studies.
We examined 60 subjects; 20 normotensive (Controls), 20 hypertensive with LV diastolic dysfunction (Group I) and 20 hypertensive without LV diastolic dysfunction (Group II). Exclusion criteria were: receiving B-blockers or non-dihydropyridine calcium channel blockers, Diabetes mellitus, Coronary heart disease and Systolic heart failure. All were examined to assess BP, left atrium and ventricle, and mitral valve flow. The Pulsed wave tissue Doppler imaging is used to assess diastolic function and AEMDs. In apical 4-chamber view, using the pulse wave Doppler, Time intervals from the onset of P wave on surface electrocardiography to the beginning of A wave (PA) were obtained from lateral mitral annulus, septal mitral annulus, and lateral tricuspid annulus and named as lateral PA, septal PA, and RV PA, respectively. The difference between septal PA and RV PA was defined as Intra-right AEMD. The difference between lateral PA and septal PA was defined as Intra-left AEMD .The difference between lateral PA and RV PA was defined as Inter-AEMD.
The Inter-AEMD was significantly higher in Group I compared with Group II and Controls. The Intra-Left AEMD was significantly higher in Group I and Group II compared with Controls. There was no significant difference between Controls and Groups as regard to Intra-Right AEMD. There was a positive correlation between systolic blood pressure, LA diameter and volume, LV mass, E/E′ from one side and Inter-AEMD and Intra-Left AEMD from the other side. There was a negative correlation between E wave, E/A ratio and E′ wave from one side and Inter-AEMD and Intra-LeftAEMD from the other side. The Inter-AEMD and the Intra-Left AEMD were significantly higher in subjects with LV hypertrophy than those without. There was no significant correlation between the Intra-Right AEMD and left ventricular hypertrophy.
The Inter-AEMD was significantly higher in hypertensive patients with diastolic dysfunction compared with those without diastolic dysfunction and controls. Intra-left AEMD was significantly higher in hypertensive patients with diastolic dysfunction and without diastolic dysfunction compared with normotensives, suggesting that diastolic dysfunction is associated with atrial electromechanical abnormalities.