Left Atrial Size in Hypertensive Patients with Atrial Fibrillation

Young Mo Kang; Wee Hyun Park

doi:10.3803/jkes.1995.3.2.179

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Kang and Park: Left Atrial Size in Hypertensive Patients with Atrial Fibrillation

Original Article

J Korean Soc Echocardiogr 1995;3(2):179-187.

Published online: 18 February 1995

DOI: https://doi.org/10.3803/jkes.1995.3.2.179

Left Atrial Size in Hypertensive Patients with Atrial Fibrillation

Young Mo Kang, Wee Hyun Park

Department of Internal Medicine Dongguk University Kyungju Hospital, Kyungju, Korea

Department of Internal Medicine Kyungpook National University Hospital, Kyungpook, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

As atrial fibrillation occurs in the patients with hypertensive heart disease, the functional abnormalities of heart become more severe and the risk of systemic and cerebral embolization increases. In this study we checked left atrial dimension and other parameters with echocardiography in hypertensive patients with atrial fibrillation.

Methods

In an attempt to define the difference in left atrial dimension and the relation between left atrial size and various echocardiographic parameters, M-mode echocardiography was used to study 63 hypertensive patients, 33 patients with atrial fibrillation, and 30 patients with sinus rhythm.

Results

The mean left atrial dimension was 51.7 ± 8.7mm in hypertensive patients with atrial fibrillation versus 39.3 ± 8.4mm in hypertensive patients with sinus rhythm(P < 0.001). In hypertensive patients with atrial fibrillation left atrial dimension was over 50mm in 82%(27 of 33). Left atrial size had positive correlations with end-systolic and -diastolic internal dimension of left ventricle(LV), LV mass and E-point septal separation, and negative correlations with fractional shortening and ejection fraction of LV.

Conclusion

The echocardiographic measurement of left atrial dimension in patients with hypertension was useful in evaluating the hypertensive heart disease.

Keywords: Left atrial size, Hypertension, Atrialfibrillation.

References

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Fig. 1.

Frequencies of atrial fibrillation(AF) and sinus rhythm(SR) in hypertensive patients(HT) according to left atrial dimension.

Fig. 2.

Correlation between left ventricular end systolic dimension(LVIDs) and left atrial dimension(LAD).

Fig. 3.

Correlation between left ventricular end diastolic dimension(LVIDd) and left atrial dimension(LAD).

Fig. 4.

Correlation between fractional shortening and left atrial dimension.

Fig. 5.

Correlation between ejection fraction and left artial dimension.

Table 1.

Clinical characteristics in the hypertensive patients

Characteristics	HTN with AF (n=33)	HTN with SR (n=30)	P value
Age, yrs	66 ± 9	55 ± 12	< 0.001
Sex, M/F	14/19	14/16	NS
Height, cm	159 ± 10	160 ± 8	NS
Weight, kg	60 ± 12	63 ± 9	<0.05
BSA, m²	1.6 ± 0.2	1.6 ± 0.2	NS
BMI, kg/m²	37.3 ± 6.1	39.4 ± 4.5	NS
Duration of HT, yrs	10 ± 7.9	10.4 ± 8.5	NS

BSA indicates body surface area; BMI, body mass index.

All values are expressed as mean ± SD.

Table 2.

Blood pressure and heart rate in the hypertensive patients

Characteristics	HT with AF (n=33)	HT with SR (n=30)	P value
SBP, mmHg	153 ± 17	165 ± 17	<0.01
DBP, mmHg	96 ± 12	104 ± 13	<0.05
MBP, mmHg	115 ± 12	124 ± 13	<0.01
HR, beats/min	94 ± 23	70 ± 18	< 0.001

SBP indicates systolic blood pressure; DBP, diastolic pressure; MBP, mean blood pressure; HR, heart rate. All values are expressed as mean ± SD.

Table 3.

Chief complaints on initial visit in the hypertensive patients

Complaints	HT with AF (n=33)	HT with SR (n=30)
Dyspnea on exertion	13(39.4%)	3(10.0%)
Headache	5(15%)	7(23.3%)
Chest Pain or discomfort	3(9.1%)	5(16.7%)
Dizziness	2(6.1%)	5(16.6%)
Motor weakness	1(3.0%)	0(0%)
Mental change	1(3.0%)	0(0%)
No symptom	3(9.1%)	6(20.0%)
Other symptom	2(6.1%)	4(13.3%)
No description	3(9.1%)	0(0%)

Table 4.

Combined diseases in the hypertensive patients

	HT with AF (n=33)	HT with SR (n=30)
Angina	3(15.2%)	4(13.3%)
Old myocardial infarction	2(6.1%)	2(6.7%)
Diabetes mellitus	5(15.2%)	1(3.3%)
Cerebrovascular accident	6(18.2%)	4(13.3%)

Table 5.

Heights of the electrocardiographic voltages in the hypertensive patients

	HT with AF	HT with SR	P value
SV_1–2, mm	18 ± 9	15 ± 5	NS
RV_5–6, mm	24 ± 8	21 ± 7	NS
SVY₂ + RV_5–6, mm	43 ± 15	36 ± 9	<0.05

Table 6.

ST-T Wave changes in the hypertensive patients

	HT with AF	HT with SR
	(n=33)	(n=30)
ST depression in V_5–6	7(21.2%)	2(6.7%)
T-inversion in V_5–6	9(27.3%)	4(13.3%)

Table 7.

Echocardiographic Measurements in the Hypertensive Patients

	HT with AF	HT with SR	P value
RV, mm	19.1 ± 4.4	17.1 ± 4.7	NS
LVIDs, mm	43.0 ± 7.0	31.5 ± 6.0	< 0.001
LVIDd, mm	55.5 ± 8.1	48.5 ± 6.2	< 0.001
LAD, mm	51.7 ± 8.7	39.3 ± 6.4	< 0.001
AORTA, mm	34.0 ± 5.1	32.9 ± 4.4	NS
STd, mm	11.5 ± 2.0	12.4 ± 2.5	NS
LVPW, mm	11.0 ± 1.8	9.8 ± 1.2	<0.01
EPSS, mm	12.7 ± 4.8	6.0 ± 2.7	< 0.001
FS	22.6 ± 7.7	35.2 ± 6.9	< 0.001
EF, %	52.3 ± 13.5	71.9 ± 8.5	< 0.001
LVM, g	327.7 ± 106.1	252.6 ± 55.2	< 0.001
LVMI, g/m²	203.9 ± 70.0	152.3 ± 34.1	< 0.001

RV indicates right ventricular dimension; LVIDs, left ventricular systolic dimension; LVIDd, left ventricular diastolic dimension; LAD, left atrial dimension: STd, septal thickness; LVPW, left ventricular posterior wall thickness; EPSS, E-point septal separation; FS, fractional shortening; EF, ejection fraction; LVM, left ventricular mass; LVMI, left ventricular mass index. All values are expressed as mean ± SD.

Table 8.

Regression equations relating to various echocardiographic parameters to left atrial dimensions

Regression Equations	Correlation Coefficient	P value
LVIDs =0.55 LAD+10.0	0.65	< 0.001
LVIDd =0.59 LAD+30.7	0.57	< 0.001
EPSS =0.29 LAD-3.8	0.55	< 0.001
LV mass =5.23 LAD+52.2	0.55	< 0.001
FS =–0.48 LAD+50.0	–0.48	< 0.001
EF =–0.75 LAD+96.1	–0.49	<0.00

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