Longitudinal Changes in Left Atrial Stiffness Index Improve Risk Stratification in Patients with Hypertension
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Left atrial (LA) stiffness index is a non-invasive echocardiographic parameter reflecting left ventricular filling pressure; however, its prognostic significance in hypertension remains unclear. We aimed to assess the prognostic value of the longitudinal change in LA stiffness index in patients with hypertension.
Methods
We analyzed 1,442 hypertensive patients from the STRATS-HHD registry who underwent echocardiography including LA and left ventricular (LV) strain at baseline and 6–18 months. Patients were categorized into four groups according to longitudinal changes in LA stiffness index: normal–normal, improved, aggravated, and persistently stiff. The primary outcome was a composite of hospitalization for heart failure (HHF) and cardiovascular death, and secondary outcomes included HHF and incident atrial fibrillation.
Results
Among 1,442 patients, 996 (69.1%) were classified as normal–normal, 173 (12.0%) as improved, 91 (6.3%) as aggravated, and 182 (12.6%) as persistently stiff. Over 5 years, aggravated (adjusted hazard ratio [aHR] 2.175, 95% confidence interval [CI] 1.048-4.515, P=0.037) and persistently stiff (aHR 2.935, 95% CI 1.697-5.076, P<0.001) groups were associated with a higher risk of the primary outcome, whereas the improved group showed a similar risk to the normal–normal group. Similar trends were observed for HHF and for incident atrial fibrillation. Adding LA stiffness index into a model including clinical factors and LV mass index improved risk prediction for composite outcomes.
Conclusions
LA stiffness index was associated with clinical outcomes in hypertension, and longitudinal changes provided additional prognostic information. Trajectory assessment may refine risk stratification.
