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Evaluation of the relationship between circadian blood pressure variation and left atrial strain measured by two-dimensional Speckle Tracking in patients admitted for acute coronary syndrome

Session Poster Session III - Friday 08:30 - 12:30

Speaker Macarena Cano-Garcia

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : hypertension
  • Sub-topic : Hypertension
  • Session type : Poster Session

Authors : M Cano-Garcia (Malaga,ES), JA Cano-Nieto (Malaga,ES), C Lara-Garcia (Malaga,ES), M Mancisidor Urkizal (Malaga,ES), JL Delgado-Prieto (Malaga,ES), M De Mora-Martin (Malaga,ES)

M Cano-Garcia1 , JA Cano-Nieto1 , C Lara-Garcia1 , M Mancisidor Urkizal1 , JL Delgado-Prieto1 , M De Mora-Martin1 , 1Regional University Hospital Carlos Haya, Cardiology - Malaga - Spain ,


Introduction/aims: Blood pressure(BP)usually fluctu­ates during the 24-hour circadian rhythm.Thus,the mean blood pressure values are 10-20% lower during the night,com­pared to daytime measurement.This condition is called "the dipper" change.In contrast,non-dippers are defined as the pa­tients without these diurnal fluctuations in blood pressure.That diurnal fluctuation of BP could affect left atrial function.This study was designed in order to investigate the effects of dipper and non-dipper status on left atrial fuction using strain imaging in patients admitted for acute coronary syndrome.

Methods: Patients hospitalized for acute coronary syndrome were enrolled in this study from September 2013 to July 2014. During hospitalization,echocardiography and 24-hour blood pressure measurement was performed in all patients.Patients were classified as non-dippers when, during night time, they had a blood pressure decrease of less than 10%.In the echocardiography,we measured left atrial size by volume 3D.Strain of the left atrium was measured during late systole.

Results: 46 patients hospitalized for acute coronary syndrome,aged between 42-75 years(mean age 63.17±9.53) were enrolled in this study. Out of 46 patients, 12 were dippers and 34 non-dippers. 75% were males(dippers 100% vs non-dippers 70.5%,p=0.032).71.7% were previously diagnosed of hypertension (75%vs70.5%,p=0.548),41.3% had diabetes(25%vs47.05%,p=0.161),63.04% dyslipidemia (75%vs50.8%,p=0.261),13.04% atrial fibrillation(0%vs17.64%,p=0.144)and 39.1% history of ischemic heart disease (40%vs35.2%,p=0.288).33 patients were admitted for Non-STEMI (75%vs70.5%,p=0.543)and 13 for STEMI (25%vs29.41%, p=0.490).Systolic and diastolic blood pressure (24 hour, daytime and night time)and variability were higher in patients with non -dipper pattern than patients with dipper pattern.In the echocardiography,left atrial diastolic and systolic volume by echocardiography 3D was higher in non-dipper pattern than dipper pattern(diastolic volume 19.95vs29.56,p=0.029; systolic volume 38.56vs46.68,p=0.049).Mean peak left atrial strain was higher in non-dipper pattern than dipper pattern (21.2±4.5%vs.25.5±6.1%,p =0.042).

 Conclusions: In our study the presence of a non-dipper pattern in patients with acute coronary syndrome results in increased filling pressures and increased left atrial size.Left atrial strain was higher in non-dipper patients, which demonstrate exaggerated reservoir and booster pump function in these patients.These methods are simple and sensitive for the early detection of subtle changes in the left atrial function.

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