TY - JOUR
T1 - Association of Cumulative Systolic Blood Pressure With Left Atrial Function in the Setting of Normal Left Atrial Size
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Van't Hof, Jeremy R.
AU - Parikh, Romil
AU - Moser, Ethan D.
AU - Inciardi, Riccardo M.
AU - Matsushita, Kunihiro
AU - Soliman, Elsayed Z.
AU - Alonso, Alvaro
AU - Shah, Amil M.
AU - Solomon, Scott D.
AU - Lutsey, Pamela L.
AU - Chen, Lin Yee
N1 - Publisher Copyright:
© 2024 American Society of Echocardiography
PY - 2024/9
Y1 - 2024/9
N2 - Background: Lower left atrial (LA) function is associated with increased risk for cardiovascular disease events; data on risk factors for impaired LA function are limited. We evaluated the effect of cumulative systolic blood pressure (cSBP) from midlife to older age on LA strain in adults with normal LA size. Methods: We included participants in the Atherosclerosis Risk in Communities study with LA strain measured on the visit 5 echocardiogram (2011-13), excluding those with atrial fibrillation and LA volume index >34 mL/m2. The cSBP was calculated from visit 1 (1987-89) through visit 5. Linear regression models were used to evaluate associations between cSBP and LA strain measures. Results: A total of 3,859 participants with a mean (SD) age of 75.2 (5.0) years were included in the analysis; 725 (18.8%) were Black and 2,342 (60.7%) were women. After adjusting for demographics, cardiovascular disease risk factors, heart failure, and coronary heart disease, each 10 mm Hg increase in cSBP was associated with 0.32% (95% CI, –0.52%, −0.13%) and 0.37% (95% CI, –0.51%, −0.22%) absolute reduction in LA reservoir and conduit strain, respectively. Associations were attenuated after adjustment for left ventricular (LV) systolic and diastolic function and mass (−0.12%: 95% CI, −0.31, 0.06 for reservoir strain; and −0.24%: 95% CI –0.38%, −0.10% for conduit strain). In subgroup analyses, the association of cSBP with conduit strain was statistically significant among those with normal LV systolic and diastolic function. Conclusions: Cumulative exposure to elevated blood pressure from midlife to late life was modestly associated with lower LA reservoir and conduit strain in older adults with normal LA size, mostly related to the effect of blood pressure on LV function and mass. However, the association of cSBP and LA conduit strain in subgroups with normal LV function suggests that LA remodeling in response to hypertension occurs before LV dysfunction is detected on echocardiography.
AB - Background: Lower left atrial (LA) function is associated with increased risk for cardiovascular disease events; data on risk factors for impaired LA function are limited. We evaluated the effect of cumulative systolic blood pressure (cSBP) from midlife to older age on LA strain in adults with normal LA size. Methods: We included participants in the Atherosclerosis Risk in Communities study with LA strain measured on the visit 5 echocardiogram (2011-13), excluding those with atrial fibrillation and LA volume index >34 mL/m2. The cSBP was calculated from visit 1 (1987-89) through visit 5. Linear regression models were used to evaluate associations between cSBP and LA strain measures. Results: A total of 3,859 participants with a mean (SD) age of 75.2 (5.0) years were included in the analysis; 725 (18.8%) were Black and 2,342 (60.7%) were women. After adjusting for demographics, cardiovascular disease risk factors, heart failure, and coronary heart disease, each 10 mm Hg increase in cSBP was associated with 0.32% (95% CI, –0.52%, −0.13%) and 0.37% (95% CI, –0.51%, −0.22%) absolute reduction in LA reservoir and conduit strain, respectively. Associations were attenuated after adjustment for left ventricular (LV) systolic and diastolic function and mass (−0.12%: 95% CI, −0.31, 0.06 for reservoir strain; and −0.24%: 95% CI –0.38%, −0.10% for conduit strain). In subgroup analyses, the association of cSBP with conduit strain was statistically significant among those with normal LV systolic and diastolic function. Conclusions: Cumulative exposure to elevated blood pressure from midlife to late life was modestly associated with lower LA reservoir and conduit strain in older adults with normal LA size, mostly related to the effect of blood pressure on LV function and mass. However, the association of cSBP and LA conduit strain in subgroups with normal LV function suggests that LA remodeling in response to hypertension occurs before LV dysfunction is detected on echocardiography.
KW - Atrial cardiopathy
KW - Cumulative blood pressure
KW - Hypertension
KW - Speckle-tracking echocardiography
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U2 - 10.1016/j.echo.2024.04.015
DO - 10.1016/j.echo.2024.04.015
M3 - Article
C2 - 38740273
AN - SCOPUS:85196027504
SN - 0894-7317
VL - 37
SP - 884
EP - 893
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 9
ER -