Left Atrial Mechanics and Atrioventricular Coupling in Hypertension With Supra-Normal Left Ventricular Ejection Fraction.

Objectives: Supra-normal left ventricular ejection fraction (snLVEF) represents a heterogeneous group with distinct prognoses. Left atrial (LA) strain, measured by speckle tracking echocardiography (STE), is a validated prognostic indicator. This study aimed to evaluate LA and left ventricular (LV) mechanical strains in hypertensive patients with snLVEF.

Methods: This retrospective study included 101 patients (mean age 59.7 ± 8.4 years; 61.4% men) with primary arterial hypertension and preserved LVEF (≥50%). Patients were categorized into low-normal LVEF (lnLVEF; 50%-59%), mid-normal LVEF (mnLVEF; 60%-69%), and snLVEF (≥70%). LV global longitudinal strain (LVGLS) and LA strains during reservoir (LASr), conduit (LAScd), and contraction (LASct) phases were measured using STE.

Results: Relative wall thickness was significantly higher in snLVEF patients compared to mnLVEF (p < 0.01), with no difference in LVGLS (p = 0.933). Compared to mnLVEF, snLVEF patients had reduced LASr and LAScd (both p < 0.01) but preserved LASct (p = 0.057). In contrast, lnLVEF patients showed greater reductions in all phasic LA strains (all p < 0.01). Loess regression revealed an inverted U-shaped relationship between LASr and LVEF, peaking at LVEF 65%-70%. The mitral E/e'_mean ratio and LVGLS correlated moderately to strongly with LASr (r = -0.39 and r = -0.65, respectively; both p < 0.001).

Conclusion: Hypertensive patients with snLVEF exhibit impaired LA reservoir and conduit functions while maintaining pump function, suggesting snLVEF may be an intermediate stage between mnLVEF and lnLVEF as hypertension progresses. Further studies are needed to explore the prognostic potential of LA strain in this population.