Left atrial phasic function in hypertensive patients with significant aortic stenosis and preserved ejection fraction

The purpose of this investigation was to evaluate the influence of hypertension on left atrial (LA) function in patients with moderate and severe AS. This cross-sectional study included 121 patients with moderate and severe AS and preserved left ventricular (LV) ejection fraction (> 50%) and 79 age-matched controls who underwent a comprehensive echocardiographic examination. LA phasic function was determined by both volumetric and strain methods. Our findings showed that the LV ejection fraction was similar between hypertensive and normotensive AS patients. Maximal, minimal, and pre-A LA volume indexes gradually increased from controls to moderate-to-severe AS patients. The total, passive and active LA emptying fraction (EF) gradually decreased in the same direction. LA phasic function estimated with strain analysis showed that reservoir, conduit, and pump LA phasic functions were lower in all AS patients than in normotensive controls. However, there was no significant difference between moderate and severe AS except in LA pump function, which was lower in severe AS. Differences in LA phasic function were more prominent in volumetric than in strain analyses. Blood pressure, LV mass index, and AS severity were independent of other clinical and echocardiographic parameters associated with LA phasic function in patients with AS. In conclusion, hypertension has an additive impact on LA phasic function in patients with moderate and severe AS. Blood pressure and AS severity were independently associated with LA phasic function parameters in AS patients. Volumetric assessment of LA phasic function should not be completely replaced with strain analysis.