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.