Preclinical Myocardial Dysfunction
Preclinical LA dysfunction is characterized by reduced reservoir and
conduit function while atrial contractile function remains
normal27 or even increased28 (Figure
3). Early in the disease spectrum, compensatory enhanced LA contractile
function is necessary for enhanced late LV filling. LA deformation
abnormalities occur prior to clear LA anatomic remodeling. Impaired
reservoir phasic performance may occur in the absence of diastolic
dysfunction or ventricular remodeling25. In patients
with normal LA size, impaired LA reservoir function is associated with
an increased risk of future heart failure
hospitalization29. In at risk hypertensive patients,
decreased LA contractile function is strongly predictive of future
adverse cardiac events and death30. Furthermore,
hypertension risk mitigation strategies including
renin-angiotensin-aldosterone system inhibitor institution leads to
improvements in LA strain31.