الفهرس 
Introduction & Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Hypertension poses a significant threat to public health and assumed to be the most major risk factor for cardiovascular disease. In developed countries, the lifetime risk of developing hypertension reaches 90%. Hypertension significantly raises the risk of adverse cardiovascular disease, such as ischemic heart disease and heart failure.
Hypertension is a manageable condition, but the choice of treatment depends on the evaluation of the overall risk of cardiovascular disease in specific individuals. Recently, a lot of studies discuss the hypertensive mediated organ damage even in controlled hypertensive patients, So, there are other factors contribute in this issue. The blood pressure variability indices obtained from ambulatory blood pressure monitoring are considered one of the not fully studied parameters that affect the overall cardiovascular risk.
Echocardiographic parameters obtained from 2D Speckle Tracking Imaging (STE) and Tissue Doppler Imaging (TDI) have been shown to be a potent indicator of cardiovascular disease in the general population. LA contributes to cardiac hemodynamics by modifying LV filling through the dynamic interaction of atrial reservoir, conduit and contractile booster function.
The LA function was evaluated from the pressure-volume curves via an invasive assessment. The non-invasive assessment of LA anatomy and function was primarily performed by volumetric and Doppler echocardiographic analyses, and other modalities. STE allows the LA function to be evaluated with reasonably high precision. More specifically, the STE strain imaging technique enables the identification of LA functional disability at a very early stage, such as in the absence of LA enlargement.
Thus, these innovative echocardiographic tools can actually be useful in the risk stratification of hypertensive individuals in the general population.
Our study was based on the previously mentioned ideas and we aimed for assessment of LA volume and function by 2D and speckle tracking echocardiography in hypertensive patients who had ambulatory blood pressure monitoring and find the correlations between blood pressure variability indices and the effect on LA volume and function.
We enrolled 121 patients and divided them into three groups based on ambulatory blood pressure monitoring. The first group (n=61) included the controlled hypertensive patients. The second group (n=40) included the uncontrolled hypertensive patients. The third group (n=20) included the non-hypertensive patients (the control group).
The main finding in our study is that the blood pressure variability indices especially average day and night time SBP reading variability were significantly correlated with the LAV and function measured through LA global longitudinal strain (GLS) in all hypertensive patients even in patients with controlled blood pressure. And the average day and night time SBP reading variability may be considered as sensitive but not specific predictors for LA dilatation.
Also, LA GLS is significantly correlated with early enlargement of the LA and was the strongest predictor that could predict LA dilatation with good sensitivity and specificity.
Another finding is that there is a significance difference between LA function assessment by 2D and speckle tracking echocardiography and the latter was more sensitive in early detection of LA dysfunction in hypertensive patients.
But there is no significant difference as regard volumetric parameters assessed by 2D or obtained from speckle tracking echocardiography.
Finally, further studies should be done on a large sample size and wide scale of populations to confirm the previously obtained results and find more variables that affect the cardiovascular risk and new imaging modalities for assessment to get the best beneficial implication on our clinical practice, decrease the morbidity and mortality and improve patient’s life.