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Late Systolic Myocardial Loading Is Associated With Left Atrial Dysfunction in Hypertension
Journal article   Peer reviewed

Late Systolic Myocardial Loading Is Associated With Left Atrial Dysfunction in Hypertension

Julio A Chirinos, Timothy S Phan, Amer A Syed, Zeba Hashmath, Harry G Oldland, Maheswara R Koppula, Ali Tariq, Khuzaima Javaid, Rachana Miller, Swapna Varakantam, …
Circulation. Cardiovascular imaging, Vol.10(6), pp.e006023-e006023
06/2017
DOI: 10.1161/CIRCIMAGING.116.006023
PMID: 28592592
url
https://doi.org/10.1161/CIRCIMAGING.116.006023View
Published (Version of record) Open Access

Abstract

Late systolic load has been shown to cause diastolic dysfunction in animal models. Although the systolic loading sequence of the ventricular myocardium likely affects its coupling with the left atrium (LA), this issue has not been investigated in humans. We aimed to assess the relationship between the myocardial loading sequence and LA function in human hypertension. We studied 260 subjects with hypertension and 19 normotensive age- and sex-matched controls. Time-resolved central pressure and left ventricular geometry were measured with carotid tonometry and cardiac magnetic resonance imaging, respectively, for computation of time-resolved ejection-phase myocardial wall stress (MWS). The ratio of late/early ejection-phase MWS time integrals was computed as an index of late systolic myocardial load. Atrial mechanics were measured with cine-steady-state free-precession magnetic resonance imaging using feature-tracking algorithms. Compared with normotensive controls, hypertensive participants demonstrated increased late/early ejection-phase MWS and reduced LA function. Greater levels of late/early ejection-phase MWS were associated with reduced LA conduit, reservoir, and booster pump LA function. In models that included early and late ejection-phase MWS as independent correlates of LA function, late systolic MWS was associated with lower, whereas early systolic MWS was associated with greater LA function, indicating an effect of the relative loading sequence (late versus early MWS) on LA function. These relationships persisted after adjustment for multiple potential confounders. A myocardial loading sequence characterized by prominent late systolic MWS was independently associated with atrial dysfunction. In the context of available experimental data, our findings support the deleterious effects of late systolic loading on ventricular-atrial coupling.
 Aged Atrial Function, Left Biomechanical Phenomena Case-Control Studies Chi-Square Distribution Female Humans Hypertension - complications Hypertension - diagnosis Hypertension - physiopathology Linear Models Magnetic Resonance Imaging, Cine Male Manometry Middle Aged Multivariate Analysis Philadelphia Stress, Mechanical Stroke Volume Systole Time Factors Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology Ventricular Function, Left

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