Background: The interest in left atrial remodelling (LAR) as a TOD in hypertension (H) has been growing recently. Little is known on the role of arterial stiffness (a.s) in the pathophysiology of LAR in H. We hypothesized that LAR precedes LVH and diastolic dysfunction (d.d.) in H and is associated with carotid a.s. independently of other possible confouders.

Methods: 85 patients–65 with H,31male and 34female,mean age55,9±10,7 years and 20 control matched subjects(C). From echocardiography: left atrial volume normalized to BSA (LA vol/BSA;ellipsoid method), LVMI, RWT, IVS, PW; from conventional and Tissue Doppler: early(E), late(A) mitral flow velocities, E/A ratio,early (e’),late(a’) diastolic mitral annular velocities, e’/a’ ratio;E/e’ratio were calculated. From carotid arteries ultrasound–IMT and high-resolution echo-tracking method a.s. parameters were evaluated: βstiffness index, Ep-elastic modulus, AC-arterial compliance, PWVβ-one-point pulse wave velocity.

Results: LAvol/BSA was the highest in H with LVH(24,9ml±6,1) and in H with d.d.(23,5ml±6). However,already in H without LVH,LA vol/BSA was significantly higher than in C (21,1ml±4,9vs18,3ml±4,8;p=0,05) and also in H without d.d. LA vol/BSA was significantly higher than in C (20,5ml±5,5vs18,3ml±4,8,p=0,048). Linear regression analysis revealed the following significant correlations between LA vol/BSA and age(r=0,3), BMI(r=0,38), mean BP(r=0,25), preload(r=0,27), afterload(r=0,24), LVMI(r=0,59), RWT(r=0,23), IVS(r=0,5), PW(r=0,42), e’(r=−0,3), E/e’(r=0,46), BNP(r=0,73), Ep(r=0,25) and PWVβ(r=0,25);p for all <0,05). However in multiple regression analysis the independent determinants were: age,BMI,mean BP,LVMI,PW,E/e’ and PWVβ.

Conclusion: LAR is one of the earliest cardiac structural changes in H that precedes LVH and d.d.Local PWVβ is an independent determinant of LAR beyond:BP components, LVH, d.d.indices.It supports the hypothesis on the contribution of arterial stiffness to LAR.