Quantitative evaluation of left atrial function via two-dimensional speckle-tracking echocardiography in patients with different grades of hypertension.

Background: Hypertension is associated with progressive structural and functional remodeling of the left atrium (LA). Two-dimensional speckle-tracking echocardiography (2D-STE) enables quantitative assessment of LA function, but its utility across different hypertension grades has not been fully clarified. This study aimed to evaluate LA structure and function in patients with different grades of hypertension via 2D-STE and to identify the key parameters associated with hypertension severity. Methods: This retrospective cross-sectional study included 145 individuals who underwent transthoracic echocardiography between March 2022 and March 2025. According to the 2023 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines, participants were classified into four groups: normotensive (n=35), grade 1 hypertension (n=33), grade 2 hypertension (n=35), and grade 3 hypertension (n=42). Conventional echocardiography and 2D-STE in apical four- and two-chamber views were used to assess LA volumetric parameters [maximum LA volume (LAVmax), minimum LA volume (LAVmin), and pre-atrial contraction LA volume (LAVpreA)], left atrial emptying fraction (LAEF), and LA strain indices [left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), and left atrial contractile strain (LASct)]. Between-group comparisons, correlation analyses, multivariable regression, and receiver operating characteristic (ROC) analysis with the DeLong test were performed to evaluate the association between key LA parameters and hypertension severity, as well as the discriminatory performance of these parameters. Results: LA volumetric indices increased progressively with hypertension grade. LAVmax, LAVpreA, and LAVmin were significantly higher in patients with grade 1 hypertension than in normotensive patients (all P values <0.05), with these values being even higher in patients with grades 2-3 hypertension. In contrast, LAEF and LA strain parameters decreased stepwise with increasing blood pressure burden (all P values <0.05), with the greatest reduction in patients with grade 3 hypertension. LA parameters were significantly correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension grade (|r|=0.48-0.80; all P values <0.001). In multivariable analyses, LAVmin, LASr, and LAEF remained independently associated with blood pressure indices and hypertension grade after adjustment for demographic and clinical covariates. ROC analysis indicated that LAVmin, LASr, and LAEF could effectively differentiate grade 3 hypertension from the lower-grade hypertension groups, with areas under the curve of 0.94, 0.89, and 0.89, respectively. In the DeLong pairwise comparisons, there were no statistically significant differences between LAVmin, LASr, and LAEF (all P values >0.05). Conclusions: LA structural enlargement and functional deterioration worsen progressively across hypertension grades. LAVmin, LASr, and LAEF are key indices for characterizing hypertension-related LA remodeling, with the most pronounced changes observed in grade 3 hypertension. Combined assessment of LA volume and strain may provide a more comprehensive evaluation of hypertensive atrial involvement.