Left Atrial Enlargement is an Early Signs of Hypertensive Heart Disease

Systemic hypertension often leads to left ventricular hypertrophy, congestive heart failure and death [1]. How to identify the early signs of hypertensive heart is the key to block or reverse the process of heart failure. The aim of this study is to evaluate the predictive value of left atrial (LA) enlargement in the early stage of hypertensive heart disease and to explore the correlation between LA enlargement and heart failure with normal ejection fraction (HFnEF). Method: This is case control study of 52 patients admitted to the hospital, 26 patients with history of hypertension (case subject) and 26 without history of hypertension were included as (Control subject). All participant underwent the standard examination and testing as well as Echocardiography (measurement of left atrial dimension, Ejection fraction, left atrial volume, mitral inflow, Left ventricle mass). Patient with valvular heart disease, atrial fibrillation or coronary disease were excluded. Result: The mean age was 69±18 year in the hypertensive patients and 66±17 year in control group. The LA dimension of hypertensive group (38±5.2) was significantly greater than control group (34.5±3.4); P<0.001) LAV and LAVI were significantly higher in hypertensive group than control group (55.5±15.5 vs 41.7±13.8 , P<0.001 28.5±7.2 vs 22.2 , P<0.001 respectively). LVM and LVMI were significantly higher in hypertensive group than in control group (174±46 vs 150±31 g, P<0.0001, 106 ±24 vs 95±16, P=0.001). Conclusion: We conclude that Echocardiographic LA enlargement may be an early sign of hypertensive heart disease in patient with no other clear cause of left atrial enlargement. Abbreviations: LA: Left Atrium; LVSF: Left ventricular systolic function; LVMI: Left Ventricular Mass Index; Echo: Echocardiography; HFnEF: Heart Failure with Normal Ejection Fraction Am J Biomed Sci & Res Copy@ Hanan KG Altalhi American Journal of Biomedical Science & Research 173 Doppler beam aligned parallel to the direction of flow and with sample volume of 1-2 mm at the mitral tips. From the mitral inflow profil, E_ and A_ wave velocities, deceleration time (DT) and the E/A ratio were measured [5]. LA diameter was measured using M-mode, from the posterior aortic wall to the posterior left atrial wall , in the parasternal long –axis view at end-ventricular systole (i.e.; just before the mitral valve opening), left atrial enlargement was defined as left atrial diameter of 4.1 cm or greater in men or 3.9 cm or greater in women, left atrial diameter below these value defined normal LA size [5]. Twodimension guided Mmode measurement of LV end –diastolic dimension (LVDd), interventricular septum (IVS) thickness and posterior wall (PW) thickness were gained in the LV minor axis at end diastole [5]. Based on the suggestion of [6], the following equation was applied to determine the LV mass in gram, where the mass can be determined from short-axis dimension using simple geometric cubic formula without measuring the major axis of LV. LV mass = 0.8x1. 04 [ (LVID + PWT + IVST )3 LVID3 ] + 0.6 Where LVID is the LV internal dimension, PWT is the posterior wall thickness , and IVST is the interventricular thickness. The LV mass index was obtained by dividing the LV mass by the body surface area. Left atrial volume was measured using the modified Simpsons method , maximum LA area , except for the confluence of pulmonary veins and the LA appendage were traced in apical 2and 4 – chamber view at end systole of the LV. LAVI was calculated as LA volume / body surface area (Lang RM, et al 2005). Other various risk factor: BP measurement in the right arm, cigarette smoking to be quantified based on daily consumption and duration of smoking. Blood biochemistry analysis was made; FBS, cholesterol, LDL, HDL, TG, CBC Statistical analysis Was performed by using SPSS software (Version 12) difference among groups was analyzed by (t-test) and P value 0.05 was considerable significant.