Arterial stiffness is associated with left atrial size in hypertensive patients

Background. - Arterial. stiffness is a strong predictor of cardiovascular events and particularly of stroke. A likely explanation is the development of atherosclerotic lesions at the carotid level, favored by increased local stiffness. Another possibility involves cardiac consequences of aortic stiffness and particutarly left atrial dilatation with its subsequent risk of atrial fibrillation (AF) and cerebral. embolism. Aims. - The present study investigated the link between arterial. stiffness, pulse pressure and left atrial. size, a determinant of AF risk. Methods. - Arterial stiffness was determined from pulse wave velocity (PWV) and pulse pressure (PP). Left atrial size was also measured. Several potential. confounders were taken into account including indices of ventricular remodeling and diastolic function (estimated by NT-Pro brain natriuretic peptide (NT-proBNP) levels). Results. - Three-hundred and ten hypertensive patients, aged 53 13 years, were included. Mean 24-h blood pressure (BP) was 154 20 over 93 +/- 13 mmHg. Significant relationships were found between left atrial, diameter (LAD) and PWV (r=0.27, P<0.001) and between LAD and 24h PP (r=0.32, P<0.001). LAD was also correlated significantly, although not always tightly, with left ventricular dimensions, geometry and NT-proBNP. In two different multivariate models, LAD remained significantly correlated with PWV or with 24-h PP, independently of classical determinants like age, gender, body mass index, ventricular remodeling (i.e. dimensions and geometry) and filling pressure. Conclusion. - These results led us to propose AF as a new possible pathophysiological link between arterial stiffness and stroke. These results also emphasize the cardiac consequences of arterial. stiffness which can fuel a new approach to AF prevention. (C) 2008 Published by Elsevier Masson SAS.