Early detection of left atrial dysfunction assessed by CMR feature tracking in hypertensive patients
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To evaluate whether early left atrial (LA) dysfunction in hypertension (HTN), with or without left ventricular hypertrophy (LVH), can be detected by cardiovascular magnetic resonance feature tracking (CMR-FT).
Seventy-three HTN patients and 29 healthy controls were retrospectively recruited. HTN patients were divided into the LVH (n = 29) and non-LVH group (n = 44). LA performance was analysed using CMR-FT in 2- and 4-chamber cine images, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster pump function (booster EF, active strain [εa], late peak negative strain rate [SRa]). One-way analysis of variance with post hoc LSD tests, Spearman analysis, receiver operating characteristic curve and intra-class correlation coefficient analysis were applied for statistical analyses.
Compared with healthy controls, LA reservoir (LA total EF, εs, SRs) and conduit function (LA passive EF, εe, SRe) were significantly impaired in HTN patients with or without LVH, and these parameters significantly correlated with mitral E/A < 1 (all p < 0.05). However, LA booster pump function was relatively preserved in non-LVH patients, representing an intermediate stage between the LVH group and controls. Among LA deformation parameters, εe showed the highest diagnostic value for differentiation of HTN patients with healthy controls (AUC, 0.82; sensitivity, 80.82%; specificity, 72.41%). Observer reproducibility was good–excellent (ICC, 0.83–0.97) for all CMR-FT derived parameters.
CMR-FT is a promising tool for quantification of LA function. LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients before the presence of LVH.
• CMR-FT is a promising tool in quantifying LA function, including deformation and volumetric parameters.
• LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients with or without LVH.
• The LA booster pump function was relatively preserved in non-LVH patients.
KeywordsHypertension Magnetic resonance imaging Atrial function
Balanced steady-state free precession
Body surface area
Cardiovascular magnetic resonance
CMR feature tracking
Diastolic blood pressure
- LA Vmax
Maximal LA volume
- LA Vmin
Minimal LA volume
- LA Vpac
Pre-atrial contractile LA volume
Left ventricular end-diastolic diameter
Left ventricle ejection fraction
Left ventricular hypertrophy
Left ventricle mass
Maximal wall thickness
Receiver operating characteristic
Systolic blood pressure
Speckle tracking imaging
This study was made possible by the wonderful work of colleagues in department of Magnetic Resonance Imaging, Fuwai hospital, Beijing, China.
This study is supported by the National Natural Science Foundation of China (Grant No.81701659 and Grant No. 81620108015) and Capital Characteristic and Clinical Application Research Fund from the Beijing Municipal Commission of Science and Technology (Z161100000516110).
Compliance with ethical standards
The scientific guarantor of this publication is Shihua Zhao.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all patients in this study.
Institutional Review Board approval was obtained.
• Performed at one institution
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