Early Detection of Increased Pulmonary Pressure in Hypertensive Patients Using Left Atrial Speckle-Tracking

Systemic hypertension is one of the causes of pulmonary hypertension (PHT) who developed heart failure with preserved ejection fraction (HFpEF). Development of PHT in HFpEF is considered as a poor prognostic factor, calls for early detection that plays an important role in decreasing morbidity and mortality in those patients. This study aimed to identify whether the global left atrial strain (GALS) %) could serve as a predictive factor for increased pulmonary pressure in hypertensive patients. One hundred essential hypertensive patients of either sex with preserved left ventricle ejection fraction (LV EF% > 55%) with a mean age of (48.6 ± 6 years) classified into 74 patients with reversed E/A ratio on PW Doppler with normal tissue Doppler image (TDI) (group I) and 26 patients with normal E/A ratio on PW Doppler and reversed Eprime/Aprime on TDI (group II). One hundred sex and aged-matched healthy individuals as control (group III). These groups were subjected to detailed history, blood pressure measurements, ECG, a list of investigations and echocardiographic study considering LV EF%, LV diastolic function using PW Doppler and TDI, left atrial volume index (LAVI) calculation, LA speckle tracking and mean pulmonary artery pressure(MPAP) calculation using right ventricular outflow tract acceleration time(RVOT-AT). The results revealed that there were significant negative linear correlations between GALS% with that of E/A, E/E prime, LAVI. In addition to significant negative linear correlations between GALS% with the estimated MPAP (r=-0.47, p=0.001). Moreover, GALS% could be served as a predictor factor for the development of pulmonary hypertension in hypertensive patients since it is strongly correlated with increased pulmonary pressure.