Early detection of left atrial dysfunction in young hypertensive patients with a normal left atrial size: a comprehensive analysis using four-dimensional auto left atrial quantification echocardiography.

Background: This study aimed to detect early left atrial (LA) function abnormalities in young hypertensive patients with a normal two-dimensional LA volume index (2D-LAVI) using four-dimensional auto LA quantification technology (4D Auto LAQ) and to analyse correlations between LA strain parameters and clinical metabolic indicators.

Methods: This study enrolled 70 young patients who underwent standard hypertension treatment or diagnosis at the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, from October 2023 to July 2024 and 41 control volunteers enrolled during the same period. LA volume and strain parameters were evaluated with a 4D Auto LAQ. A correlation analysis was conducted between the clinical and strain parameters.

Results: Compared with the control group, young hypertensive patients presented significantly greater LA minimum volume (LAVmin), LA minimum volume index (LAVImin) and LA pre-atrial volume (LAVpreA) values (all p < 0.001). The LA ejection fraction (LAEF) was reduced in young hypertensive patients (57.85%±4.47% vs. 50.44%±5.96%, p < 0.001), along with LA reservoir longitudinal strain (25.00% [20.50-29.50%] vs. 20.00% [16.00-24.25%], p < 0.001), LA conduit longitudinal strain (-16.32%±4.19% vs. -11.37%±4.65%, p < 0.001), LA contraction longitudinal strain (-12.27%±2.85% vs. -9.60 ± 4.12, p < 0.001), LA reservoir circumferential strain (34.32%±6.90% vs. 28.41%±6.95%, p < 0.001), LA conduit circumferential strain (-17.90%±4.84% vs. -11.46%±4.96%, p < 0.001), and LA contraction circumferential strain (-18.54%±4.85% vs. -16.23%±6.11%, p < 0.05). Multivariate linear regression analysis revealed that body mass index (BMI), triglyceride (TG), and uric acid (UA) were negatively and independently correlated with LA longitudinal strain.

Conclusions: In young hypertensive patients with normal 2D-LAVI, while LAVmin, LAVImin and LAVpreA are elevated, the LAEF and LA reservoir, conduit, and contraction strain are notably reduced. The application of 4D Auto LAQ technology may highlight altered values in young hypertensive patients with normal 2D-LAVI. 4D Auto LAQ may serve as a valuable tool for clinicians in the early detection and assessment of LA dysfunction in young hypertensive patients.