Impaired left atrial mechanical functions as indicators for increased aortic root diameter in hypertensive and diabetic
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Ezgi Kalaycıoğlu1 · Mustafa Çetin2 · Ali Gökhan Özyıldız2
· Tuncay Kırış3
1
Ahi Evren Thoracic and Cardiovascular Surgery Education and Research Hospital, Department of Cardiology, University of Health Sciences Turkey, Trabzon, Turkey 2 Faculty of Medicine, Training and Research Hospital, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey 3
Atatürk Training and Research Hospital, Department of Cardiology, İzmir Katip Çelebi University, İzmir, Turkey
Impaired left atrial mechanical functions as indicators for increased aortic root diameter in hypertensive and diabetic patients Introduction Previous studies have shown that aortic root diameter (ARD) is associated with cardiovascular (CV) mortality, cardiac events, left ventricular (LV) diastolic dysfunction, and heart failure, independent of conventional CV risk factors [1–3]. ARD is also a predictor of stroke [3]. Nevertheless, consensus is lacking on the underlying mechanisms and clinical importance of ARD. In recent years, the role of the left atrium (LA) in indicating CV events has been widely investigated [4]. LA mechanical dispersion has been highlighted as a useful predictor in detecting newonset atrial fibrillation (AF) independent of LA enlargement and dysfunction [5]. Atrial remodeling is based on various pathophysiologic processes, and there are different manifestations of LA remodeling such as structural, functional, and electrical signs [6]. LA deformation analyses using two-dimensional speckle tracking echocardiography (2D-STE) is superior to conventional echocardiography in detecting subtle changes in LA function [7, 8]. In 2D-STE, myocardial motion is analyzed by frame-by-frame tracking of natural acoustic markers, generated from interactions between ultrasound and myocardial tissue, with-
out angle dependency [4]. Left atrial strain is inversely associated with LA fibrosis, as shown by cardiac magnetic resonance. Left atrial scarring can be a more specific marker than LA volume and global function [5]. Hypertension (HT) and diabetes mellitus (DM) are well-known CV risk factors, especially when they present simultaneously [9]. In the present study, we hypothesized that impaired LA mechanical functions determined by echocardiographic speckle tracking evaluation might related with increased ARD in patients with hypertension and diabetes.
block, moderate to severe valvular heart disease, history of cerebrovascular disease, hyperhypothyroidism, and patients with liver enzymes three times higher than the reference range. Seventeen patients with poor acoustic windows were also excluded from the study. The remaining 93 patients constituted the study population. Overnight fasting venous blood samples were drawn from the antecubital vein. Body mass index (BMI) was calculated as weight (kg)/height (m2). All patients gave informed consent and the local ethics board approved the study.
Methods
Conventional echocardiography
Study population
The echocardiographic studies, including two-dimensional, M-mode, pulsed Doppler, and pulsed tissu
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