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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
M Mancisidor Urkizal1
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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