Left atrial volume index (lavi) as a predictor of paroxysmal atrial fibrillation in patients with resistant arterial hypertension

Objective: Heart damage in hypertension occurs at three stages, a compensatory, reversible subclinical and irreversible clinical phase. Atrial fibrillation appears in the third phase, but we can find echocardiographic signs pointing to it in the subclinical phase. Although cardioembolic stroke is a feared cardiovascular complication with a possible life-long impact on a patient’s health, silent atrial fibrillation is not routinely screened in patients with advanced hypertension. The aim of the work was to assess the relationship of left atrial dilation and silent atrial fibrillation in patients with resistant arterial hypertension. Design and method: Data were collected in 211 patients with arterial hypertension treated with at least three combinations of antihypertensives with no prior history of atrial fibrillation. The first 109 patients with paroxysmal atrial fibrillation detected at 24-hour monitoring were assigned 102 age-appropriate controls with normal ECG Holter. Transthoracic echocardiography was performed on all patients, comparing baseline parameters of systolic and diastolic function - ejection fraction (EF), E/A velocity ratio, E/e motion velocity ratio, LAVI and peak tricuspid regurgitation gradient (PPG TR). Results: Patients with arterial hypertension and newly captured paroxysmal atrial fibrillation had a significantly higher E wave height (p = 0.005), a higher E/A ratio (p = 0.0004), a comparable E/e’ (p = 0.21), a higher PPG TR (p = 0.045) and a significantly greater left atrial indexed volume-LAVI (36.1 ± 10.3 vs 31.0 ± 9.6, p = 0.0002). Conclusions: Patients with resistant arterial hypertension and paroxysmal atrial fibrilation have significantly higher indexed left atrial volume. Patients with increased LAVI may benefit from performing extended cardiac rhythm monitoring in the prevention of cardioembolic events.