Left ventricular diastolic dysfunction was more pronounced in STEMI patients with previous hypertension, indicated by significantly higher E/E′ avg (p = 0.001).
Does previous hypertension impair left ventricular and left atrial function in STEMI patients treated with primary PCI?
Previous hypertension in STEMI patients is associated with early left atrial and left ventricular diastolic dysfunction detectable by advanced echocardiography before structural enlargement occurs.
Absolute Event Rate: 0% vs 0%
Abstract Background Hypertension (HTA) is a well-known risk factor for adverse cardiovascular remodeling and may influence left ventricular (LV) diastolic function and left atrial (LA) mechanics in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). While LV ejection fraction (LVEF) remains a key parameter in post-STEMI assessment, it does not fully capture diastolic dysfunction or atrial remodeling, which may be particularly relevant in patients with prior hypertension. Objective This study aims to evaluate the influence of previous HTA on LV and LA function in STEMI patients treated with pPCI, using both conventional echocardiographic parameters and advanced echocardiographic techniques. Methods The study included patients prospectively admitted for the first STEMI and treated with pPCI in a tertiary centre. Conventional and advanced 2D speckle-tracking echocardiography were performed according to EACVI guidelines at discharge from the CCU and analyzed using dedicated software. LV function was assessed using end-systolic volume index (ESVi), left ventricular mass index (LVMi), LV EF, global longitudinal strain (LV GLS), and myocardial work indices: global constructive work (LV GCW), global wasted work (LV GWW), and global work efficiency (LV GWE). Diastolic function was assessed using E/E′ avg as a marker of LV filling pressure. LA function was evaluated through left atrial volume index (LAVi), and left atrial strain indices: reservoir phase strain (LAS-r), conduit phase strain (LAS-cd), and contraction phase strain (LAS-c), reflecting LA contractile function. Results A total of 403 patients with first STEMI, successfully treated with pPCI, were included and 262 (65%) patients had previous HTA Results are summarized in Table 1. LV diastolic dysfunction was more pronounced in HTA patients, as indicated by a significantly higher E/E′ avg (p = 0.001). LA function was significantly impaired in HTA patients, with lower LAS-r (p 0.001), lower LAS-c (p = 0.011), and reduced LA contractile function. Importantly, LAVi was not significantly different between HTA and non-HTA patients, suggesting that functional impairment in LA mechanics precedes structural enlargement in this population. Among LV parameters, the only significant difference between groups was in LV GWW, indicating increased energetic inefficiency in hypertensive patients. In contrast, LV GLS, LV GCW, and LV GWE did not differ significantly between groups (p = ns), reinforcing the role of LA dysfunction and LV diastolic dysfunction as primary markers of hypertensive myocardial impairment. Conclusion These findings highlight the importance of assessing LA strain and LV diastolic dysfunction in hypertensive STEMI patients, as they may serve as early markers of post-infarction remodeling and help guide risk stratification and therapeutic strategies.
Krljanać et al. (Thu,) reported a other. Left ventricular diastolic dysfunction was more pronounced in STEMI patients with previous hypertension, indicated by significantly higher E/E′ avg (p = 0.001).