Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure

Maryam Alsharqi; Odaro Huckstep; Winok Lapidaire; Wilby Williamson; Afifah Mohamed; Cheryl Tan; Jamie Kitt; Holger Burchert; Fernando Telles; Helen Dawes; Charlie E M Foster; oxford Cardiovascular; Paul Leeson

doi:10.1111/echo.15149

Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure

Maryam Alsharqi, Odaro Huckstep, Winok Lapidaire, Wilby Williamson, Afifah Mohamed , Cheryl Tan, Jamie Kitt, Holger Burchert, Fernando Telles, Helen Dawes, Charlie E M Foster, oxford Cardiovascular, Paul Leeson^*

^*Corresponding author for this work

School for Policy Studies

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Abstract

Aims: To investigate the left ventricular response to exercise in young adults with hypertension, and identify whether this response can be predicted from changes in left atrial function at rest. Methods: A total of 127 adults aged 18 to 40 years who completed clinical blood pressure assessment and echocardiography phenotyping at rest and during cardiopulmonary exercise testing, were included. Measurements were compared between participants with suboptimal blood pressure ≥120/80mmHg (n=68) and optimal blood pressure <120/80mmHg (n=59). Left ventricular systolic function during exercise was obtained from an apical four chamber view, while resting left atrial function was assessed from apical four and two chamber views. Results: Participants with suboptimal blood pressure had higher left ventricular mass (p=0.031) and reduced mitral E velocity (p=0.02) at rest but no other cardiac differences. During exercise, their rise in left ventricular ejection fraction was reduced (p=0.001) and they had higher left ventricular end diastolic and systolic volumes (p=0.001, and p=0.001 respectively). Resting cardiac size predicted left ventricular volumes during exercise but only left atrial booster pump function predicted the left ventricular ejection fraction response (β=0.29, p=0.011). This association persisted after adjustment for age, sex, body mass index and mean arterial pressure. Conclusion: Young adults with suboptimal blood pressure have a reduced left ventricular systolic response to exercise, which can be predicted by their left atrial booster pump function at rest. Echocardiographic measures of left atrial function may provide an early marker of functionally relevant, subclinical, cardiac remodelling in young adults with hypertension.

Original language	English
Pages (from-to)	1319-1326
Number of pages	8
Journal	Echocardiography
Volume	38
Issue number	8
Early online date	29 Jun 2021
DOIs	https://doi.org/10.1111/echo.15149
Publication status	Published - Aug 2021

Bibliographical note

Funding Information:
This work was funded by The British Heart Foundation (BHF) [BHF grant numbers PG/13/58/30397]; the Wellcome Trust [Ref 105741/Z/14/Z]; the Oxford BHF Centre for Research Excellence; and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and Oxford Health Services Research Committee (OHSRC). Maryam Alsharqi is funded by a scholarship grant from Imam Abdulrahman Bin Faisal University.

Publisher Copyright:
© 2021 The Authors. Echocardiography published by Wiley Periodicals LLC.

Research Groups and Themes

SPS Exercise, Nutrition and Health Sciences

Keywords

Young adults
hypertension
exercise echocardiography
exercise ejection fraction
left atrial strain
speckle tracking echocardiography

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Alsharqi, M., Huckstep, O., Lapidaire, W., Williamson, W., Mohamed , A., Tan, C., Kitt, J., Burchert, H., Telles, F., Dawes, H., Foster, C. E. M., Cardiovascular, O., & Leeson, P. (2021). Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure. Echocardiography, 38(8), 1319-1326. https://doi.org/10.1111/echo.15149

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title = "Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure",

abstract = "Aims: To investigate the left ventricular response to exercise in young adults with hypertension, and identify whether this response can be predicted from changes in left atrial function at rest. Methods: A total of 127 adults aged 18 to 40 years who completed clinical blood pressure assessment and echocardiography phenotyping at rest and during cardiopulmonary exercise testing, were included. Measurements were compared between participants with suboptimal blood pressure ≥120/80mmHg (n=68) and optimal blood pressure <120/80mmHg (n=59). Left ventricular systolic function during exercise was obtained from an apical four chamber view, while resting left atrial function was assessed from apical four and two chamber views. Results: Participants with suboptimal blood pressure had higher left ventricular mass (p=0.031) and reduced mitral E velocity (p=0.02) at rest but no other cardiac differences. During exercise, their rise in left ventricular ejection fraction was reduced (p=0.001) and they had higher left ventricular end diastolic and systolic volumes (p=0.001, and p=0.001 respectively). Resting cardiac size predicted left ventricular volumes during exercise but only left atrial booster pump function predicted the left ventricular ejection fraction response (β=0.29, p=0.011). This association persisted after adjustment for age, sex, body mass index and mean arterial pressure. Conclusion: Young adults with suboptimal blood pressure have a reduced left ventricular systolic response to exercise, which can be predicted by their left atrial booster pump function at rest. Echocardiographic measures of left atrial function may provide an early marker of functionally relevant, subclinical, cardiac remodelling in young adults with hypertension. ",

keywords = "Young adults, hypertension, exercise echocardiography, exercise ejection fraction, left atrial strain, speckle tracking echocardiography",

author = "Maryam Alsharqi and Odaro Huckstep and Winok Lapidaire and Wilby Williamson and Afifah Mohamed and Cheryl Tan and Jamie Kitt and Holger Burchert and Fernando Telles and Helen Dawes and Foster, {Charlie E M} and oxford Cardiovascular and Paul Leeson",

note = "Funding Information: This work was funded by The British Heart Foundation (BHF) [BHF grant numbers PG/13/58/30397]; the Wellcome Trust [Ref 105741/Z/14/Z]; the Oxford BHF Centre for Research Excellence; and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and Oxford Health Services Research Committee (OHSRC). Maryam Alsharqi is funded by a scholarship grant from Imam Abdulrahman Bin Faisal University. Publisher Copyright: {\textcopyright} 2021 The Authors. Echocardiography published by Wiley Periodicals LLC.",

year = "2021",

month = aug,

doi = "10.1111/echo.15149",

language = "English",

volume = "38",

pages = "1319--1326",

journal = "Echocardiography",

issn = "1540-8175",

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TY - JOUR

T1 - Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure

AU - Alsharqi, Maryam

AU - Huckstep, Odaro

AU - Lapidaire, Winok

AU - Williamson, Wilby

AU - Mohamed , Afifah

AU - Tan, Cheryl

AU - Kitt, Jamie

AU - Burchert, Holger

AU - Telles, Fernando

AU - Dawes, Helen

AU - Foster, Charlie E M

AU - Cardiovascular, oxford

AU - Leeson, Paul

N1 - Funding Information: This work was funded by The British Heart Foundation (BHF) [BHF grant numbers PG/13/58/30397]; the Wellcome Trust [Ref 105741/Z/14/Z]; the Oxford BHF Centre for Research Excellence; and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and Oxford Health Services Research Committee (OHSRC). Maryam Alsharqi is funded by a scholarship grant from Imam Abdulrahman Bin Faisal University. Publisher Copyright: © 2021 The Authors. Echocardiography published by Wiley Periodicals LLC.

PY - 2021/8

Y1 - 2021/8

N2 - Aims: To investigate the left ventricular response to exercise in young adults with hypertension, and identify whether this response can be predicted from changes in left atrial function at rest. Methods: A total of 127 adults aged 18 to 40 years who completed clinical blood pressure assessment and echocardiography phenotyping at rest and during cardiopulmonary exercise testing, were included. Measurements were compared between participants with suboptimal blood pressure ≥120/80mmHg (n=68) and optimal blood pressure <120/80mmHg (n=59). Left ventricular systolic function during exercise was obtained from an apical four chamber view, while resting left atrial function was assessed from apical four and two chamber views. Results: Participants with suboptimal blood pressure had higher left ventricular mass (p=0.031) and reduced mitral E velocity (p=0.02) at rest but no other cardiac differences. During exercise, their rise in left ventricular ejection fraction was reduced (p=0.001) and they had higher left ventricular end diastolic and systolic volumes (p=0.001, and p=0.001 respectively). Resting cardiac size predicted left ventricular volumes during exercise but only left atrial booster pump function predicted the left ventricular ejection fraction response (β=0.29, p=0.011). This association persisted after adjustment for age, sex, body mass index and mean arterial pressure. Conclusion: Young adults with suboptimal blood pressure have a reduced left ventricular systolic response to exercise, which can be predicted by their left atrial booster pump function at rest. Echocardiographic measures of left atrial function may provide an early marker of functionally relevant, subclinical, cardiac remodelling in young adults with hypertension.

AB - Aims: To investigate the left ventricular response to exercise in young adults with hypertension, and identify whether this response can be predicted from changes in left atrial function at rest. Methods: A total of 127 adults aged 18 to 40 years who completed clinical blood pressure assessment and echocardiography phenotyping at rest and during cardiopulmonary exercise testing, were included. Measurements were compared between participants with suboptimal blood pressure ≥120/80mmHg (n=68) and optimal blood pressure <120/80mmHg (n=59). Left ventricular systolic function during exercise was obtained from an apical four chamber view, while resting left atrial function was assessed from apical four and two chamber views. Results: Participants with suboptimal blood pressure had higher left ventricular mass (p=0.031) and reduced mitral E velocity (p=0.02) at rest but no other cardiac differences. During exercise, their rise in left ventricular ejection fraction was reduced (p=0.001) and they had higher left ventricular end diastolic and systolic volumes (p=0.001, and p=0.001 respectively). Resting cardiac size predicted left ventricular volumes during exercise but only left atrial booster pump function predicted the left ventricular ejection fraction response (β=0.29, p=0.011). This association persisted after adjustment for age, sex, body mass index and mean arterial pressure. Conclusion: Young adults with suboptimal blood pressure have a reduced left ventricular systolic response to exercise, which can be predicted by their left atrial booster pump function at rest. Echocardiographic measures of left atrial function may provide an early marker of functionally relevant, subclinical, cardiac remodelling in young adults with hypertension.

KW - Young adults

KW - hypertension

KW - exercise echocardiography

KW - exercise ejection fraction

KW - left atrial strain

KW - speckle tracking echocardiography

U2 - 10.1111/echo.15149

DO - 10.1111/echo.15149

M3 - Article (Academic Journal)

C2 - 34185918

SN - 1540-8175

VL - 38

SP - 1319

EP - 1326

JO - Echocardiography

JF - Echocardiography

IS - 8

ER -

Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure

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