Transesophageal echocardiography assessment of left atrial appendage function in untreated systemic hypertensive patients in sinus rhythm

To assess left atrial appendage (LAA) function in hypertensive patients wit hout treatment, transesophageal echocardiography (TEE) was performed in 46 hypertensive patients in sinus rhythm, aged 40 to 55 years, and in 16 contr ol subjects (group I) without cardiovascular disease, aged 41 to 54 years. The hypertensive patients were divided into 2 groups according to left vent ricular (LV) systolic function: group II, the group with normal LV systolic function (ejection fraction 0.63 +/- 0.08), and group III, the group with LV systolic dysfunction (ejection fraction 0.39 +/- 0.05). The LAA late emp tying velocities (EVs) were significantly reduced in the hypertensive subgr oups compared with the control group (P < .001), but no significant differe nce in the LAAEV was found between groups Il and III. The LAAEV in the hype rtensive patients had a significant negative correlation with diastolic blo od pressure, systolic blood pressure, and left atrial (LA) diameter. The ma ximal LAA areas were significantly larger in the hypertensive subgroups tha n in the control group (P < .05). No significant difference in LAA maximal area existed between groups II and III. The maximal LAA area in the hyperte nsive patients had a significant positive correlation with diastolic blood pressure, systolic blood pressure, and LA diameter, but a significant negat ive correlation with LV ejection fraction. With TEE, LA spontaneous echocar diographic contrast (SEC) was present in 6 (43%) of 14 patients in group II I (P < .01) and in 7 (22%) of 32 patients in group II (P < .05). No signifi cant difference in the occurrence of LASEC was found between groups II and III. Left atrial appendage thrombi by TEE were observed in 4 (29%) of 14 pa tients in group III (P < .05) and in 4 (13%) of 32 patients in group II (P = not significant). No significant difference in the occurrence of LAA thro mbus existed between groups II and III. In conclusion, in patients with unt reated hypertension, marked elevation of afterload imposed on the left atri um may involve both the left atrium and the LAA, resulting in impairment of LAA function. This condition may worsen with subsequent occurrence of SEC and later, thrombus formation. Therefore assessment of LAA function may be important even in the hypertensive patient in sinus rhythm.