Arterial Loading and the Prevention of Atrial Dysfunction
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The presence of left atrial (LA) dysfunction is linked to the development of both heart failure and atrial fibrillation (AF). Hypertensive heart disease is an important contributor to both LA dysfunction and AF, and hypertension is present in between 50% and 90% of patients in AF trials.1 In the early phases of hypertension, LA conduit function is impaired, and there is compensation by increased booster function.2 Although the association of LA dysfunction with heart failure may be mediated through left ventricular (LV) systolic and diastolic dysfunction,3 the eventual loss of booster function because of AF is an important precipitant of heart failure. Consequently, it seems logical that controlling hypertension and its LV consequences may be a factor in the prevention of AF. Specifically, because LA dysfunction, wall stretch, and enlargement are a consequence of disturbances of LV hemodynamics, a better understanding of the LV systolic–diastolic coupling may have an important role in protecting the LA.
See Article by Chirinos et al
The historical approach to LV wall stress was that it reflected systolic pressure, wall thickness, and ventricular dimensions.4 However, this was a simplification of the contributors to wall stress, including failure to account for ventricular shape,5 tissue properties, and especially the time course of systolic pressure. Exposure of the LV to late systolic load has effects on LV shape, which in turn may be an important interactive link between LV systole and diastole. A recent literature has linked the timing of wall stress to diastolic dysfunction in both community6 and hypertension-based populations.7 The implication is that it is inaccurate to calculate systolic wall stress at a single time point. …