Early detection of abnormal left atrial-left ventricular-arterial coupling in preclinical patients with cardiovascular risk factors: evaluation by two-dimensional speckle-tracking echocardiography

Aims Data are lacking on the left atrial (LA)-left ventricular (LV)-arterial coupling for evaluating the functional abnormalities in the left heart disease, whereas LA-LV or LV-arterial coupling has been recognized. This study was designed to earlier detect the abnormal LA-LV-arterial coupling using two-dimensional speckle-tracking echocardiography (2DSTE) in patients with cardiovascular risk factors and no overt cardiovascular disease. Methods and results We studied 30 age-matched healthy individuals and 64 preclinical patients with cardiovascular risk factors, who measured carotid arterial intima-media thickness and stiffness beta by M-mode ultrasonography, and strain and strain rate of the LA and LV walls by 2DSTE. The stiffness beta and LA volume index (LAVI) were greater in the patient group than in the control group. However, the peak systolic LV longitudinal strain, peak systolic and early diastolic LV longitudinal strain rates, peak systolic and early diastolic LA strains and strain rates, and peak atrial systolic LA strain rate were lower in the patient group. There were correlations between the stiffness beta and the age, pulse pressure, LAVI, peak early diastolic LV longitudinal strain rate, and all LA strains and strain rate variables. Multivariate regression analysis indicated that peak early diastolic LV longitudinal strain rate and peak LA strain rate during ventricular systole are defined as strong predictors related to stiffness beta. Conclusion Impaired LA and LV relaxation in the longitudinal direction are early signs of abnormal LA-LV coupling related to arterial stiffness in preclinical patients with cardiovascular risk factors. 2DSTE enables the quantitative assessment of the LA and LV function, and can be considered a sensitive tool for detecting the abnormal LA-LV-arterial coupling.