Left atrial enlargement and right ventricular hypertrophy in essential hypertension

Figures & data

Table I. Demographic and clinical characteristics of the study population categorized according to tertiles of left atrial diameter indexed to body surface area.

Variable	I (n = 110)	II (n = 110)	III (n = 110)	p-value
Age (years)	52.9 ± 12.1	57.9 ± 11.3^a	64.4 ± 10.5^d	< 0.01
Gender (% women)	21.9	41.0^a	51.9^d	< 0.01
BSA (m^2)	1.97 ± 0.16	1.86 ± 0.17^a	1.77 ± 0.16^d	< 0.01
BMI (kg/m^2)	26.7 ± 4.1	26.6 ± 3.6	25.8 + 3.4	NS
Abd. circumference (cm)	95.0 ± 11.5	94.8 ± 10.4	92.1 ± 10.4^d	< 0.01
Office SBP (mmHg)	138 ± 13	140 ± 14	139 ± 14	NS
Office DBP (mmHg)	89 ± 9	90 ± 9	84 ± 9^d	< 0.01
Heart rate (b/min)	68 ± 10	68 ± 10	64 ± 9^d	< 0.01
Hypertension duration (years)	8.2 ± 8.1	9.1 ± 7.2	10.0 ± 7.7	NS
Sokolow–Lyon (mm)	20.3 ± 5.9	19.7 ± 5.6	19.5 ± 5.9	NS
Plasma glucose (mg/dl)	103.2 ± 29.6	98.8 ± 13.9	107.4 ± 30.9^c	< 0.01
HDL Cholesterol (mg/dl)	54.8 ± 13.4	58.6 ± 16.2	60.3 ± 18.4^b	< 0.01
LDL Cholesterol (mg/dl)	136.5 ± 32.3	139.6 ± 34.5	131.9 ± 35.8	NS
Triglycerides (mg/dl)	136.2 ± 110.4	128.4 ± 78.3	133.8 ± 72.4	NS
Serum creatinine (mg/dl)	1.09 ± 0.28	0.97 ± 0.17^a	1.04 ± 0.27	< 0.01
Metabolic syndrome (%)	43.0	38.0	56.8	NS
Antihypertensive therapy (%)	85.5	89.1	93.7	NS
Combination therapy (%)	58.2	62.4	71.2	NS

Data are shown as means ± SD or percentage, p-values are based on ANOVA (for continuous measures) or chi-square test (for categorical variables). BSA, body surface area; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; combination therapy, two or more antihypertensive drugs. p < 0.01, ^aII vs I, ^bIII vs I, ^cIII vs II, ^dII vs II and I.

Table II. Echocardiographic parameters of the left and right chambers in the study population categorized according to tertiles of left atrial diameter indexed to body surface area.

Variable	I (n = 110)	II (n = 110)	III (n = 110)	p-value
LVIDd (mm)	48.9 ± 3.9	48.7 ± 3.7	48.6 ± 3.7	NS
IVSTd (mm)	10.3 ± 1.3	10.2 ± 1.4	10.2 ± 1.3	NS
PWTd (mm)	9.0 ± 1.0	8.9 ± 0.9	9.1 ± 1.0	NS
LVRWT (mm)	0.40 ± 0.05	0.39 ± 0.05	0.40 ± 0.04	NS
LA diameter, a/p (mm)	33.6 ± 3.4	36.4 ± 3.5^a	39.7 ± 3.7^d	< 0.01
LV mass (g)	199.3 ± 46.9	193.9 ± 46.9	194.8 ± 51.2	NS
LV mass index (g/h^2.7)	43.6 ± 9.7	46.8 ± 9.5^a	49.8 ± 11.4^d	< 0.01
mFS (%)	19.3 ± 2.2	19.0 ± 2.1	19.7 ± 2.2	NS
(E/A)m ratio	1.17 ± 0.39	1.02 ± 0.34^a	0.94 ± 0.32^b	< 0.01
DTm (ms)	219.1 ± 45.0	220.2 ± 56.7	227.8 ± 59.8	NS
RVDd (outflow) (mm)	26.5 ± 4.0	26.8 ± 3.7	27.2 ± 4.2	NS
RVTd (outflow) (mm)	5.4 ± 1.0	5.5 ± 1.0	5.5 ± 0.9	NS
RA diameter, long axis (mm)	44.5 ± 3.8	45.2 ± 4.0	45.6 ± 4.3^b	< 0.01
(E/A)t ratio	1.37 ± 0.34	1.28 ± 0.34	1.23 ± 0.36^b	< 0.01
DTt (ms)	216.2 ± 61.4	224.2 ± 59.6	229.2 ± 58.9	NS

LVIDd, left ventricular internal diameter diastole; IVSTd, interventricular septum thickness in diastole; PWTd, posterior wall thickness in diastole; LA, left atrium; a/p, antero-posterior; LVM, left ventricular mass; LVRWT, left ventricular relative wall thickness; mFS, mid-wall fractional shortening; E_m, early diastolic mitral flow; A_m, late diastolic mitral flow; DT, deceleration time; RVDd, right ventricular diameter in diastole; RVTd, right ventricular thickness in diastole; E_t, early diastolic tricuspid flow; A_t, late diastolic tricuspid flow; RA, right atrium. p < 0.01, ^aII vs I, ^bIII vs I, ^cIII vs II, ^dIII vs II and I.

Figure 1. Prevalence rates of biventricular hypertrophy in hypertensive subjects divided according to tertiles of left atrial antero-posterior diameter indexed to body surface area. p < 0.01, III vs I.

Table IIIa. Univariate correlations between right anterior wall thickness and demographic/clinical characteristics in the study population (n = 330).

Variable	r	p
Age	0.19	< 0.001
Abdominal circumference	0.30	< 0.0001
Clinic SBP	0.18	< 0.001
Duration HTN	0.03	NS
Plasma glucose	0.14	NS
LDL Cholesterol	0.01	NS
Triglycerides	0.11	NS
Serum creatinine	0.14	NS
LVMI	0.40	< 0.0001
Left atrium diameter	0.24	< 0.0001
Left atrium diameter/BSA	0.02	NS
Mid-wall shortening	0.25	< 0.0001
(E/A)m ratio	0.17	0.002
Et/At ratio	0.13	NS
Deceleration time M	0.13	NS
Deceleration time T	0.22	< 0.0001

SBP, systolic blood pressure; HTN, hypertension; LDL, low-density lipoprotein; LVMI, left ventricular mass index; BSA, body surface area; E_m, early diastolic mitral flow; A_m, late diastolic mitral flow; E_t, early diastolic tricuspid flow; A_t, late diastolic tricuspid flow; M = mitral; T = tricuspid.

Table IIIb. Multivariate regression analysis of independent variables associated with right anterior wall thickness in the study population (n = 330).

	Beta	SE	p-value
Age	0.152	0.006	0.01
Abdominal circumference	0.203	0.005	0.0005
Clinic SBP	0.073	0.004	0.166
LVMI	0.252	0.003	< 0.0001
Left atrium diameter	0.021	0.014	0.729
Mid-wall shortening	− 0.168	0.024	< 0.002
Em/Am ratio	0.032	0.184	0.627
Deceleration time T	0.029	0.001	0.575

Adjusted R² = 0.47. SBP, systolic blood pressure; LVMI, left ventricular mass index; E_m, early diastolic mitral flow; A_m, late diastolic mitral flow, T = tricuspid.