Abstract 11809: Impact of Strong Lipophilic Statin on Left Ventricular Properties and the Incidence of Atrial Fibrillation in Elderly Patients With Hypertension; A Prospective Four-Years Study
Background: Strong lipophilic statins may attenuate cardiac hypertrophy. We assessed the hypothesis that a strong lipophilic statin (pitavastatin) could prevent left atrial (LA) remodeling and new-onset atrial fibrillation (AF) through preservation of diastolic function and lowering of pulmonary capillary wedge pressure (PCWP) in hypertension (HTN).
Methods: Elderly patients with HTN and left ventricular ejection fraction (LVEF) > 50% but no history of AF were prospectively enrolled and divided to 2 groups: HTN with statin (n=140, age 72±5) and HTN without statin (n=234, age 73±6). LA volume (V), emptying function (EF), strain, strain rate (SR), stiffness and PCWP were obtained by speckle tracking echocardiography. PCWP was estimated as 10.7 - 12.4 x log (active LAEF / minimum LAV), as we previously reported. LA stiffness was defined as PCWP / LA strain. LV mass, LVEF and E/e’ were measured. All patients were followed for 4 years.
Results: There were no differences in BP, cholesterol or LVEF between the 2 groups. LV mass, E/e’ and PCWP were lower in HTN patients treated with statin than without (109±24 vs. 115±24 g/m2, 8.7±1.5 vs. 9.1±1.8 and 10.1±2.8 vs. 12.0±3.3 mmHg, p<0.05). LA function in HTN patients with statin was better preserved (active EF: 29±7 vs. 25±8%, SR during atrial contraction: -1.4±0.4 vs. -1.2±0.5S-1; and stiffness: 0.4±0.2 vs. 0.6±0.5, p<0.05). HTN without statin had more new-onset AF over 4 years (20 vs. 6%, p<0.01), and this was associated with increased LAV, E/e’, PCWP, LA stiffness and reduced LAEF. There was greater PCWP and LA stiffness in HTN with than without AF (14.8±3.4 vs. 10.7±2.9 mmHg and 0.9±0.8 vs. 0.5±0.2, respectively). In multivariate analysis, PCWP was the strongest predictor of new-onset AF. Using 13mmHg of PCWP as a cutoff, the sensitivity and specificity to predict new-onset AF were 75 and 78%, respectively.
Conclusions: Treatment of HTN with pitavastatin preserved LA volume and function, and this was associated with lower LV mass, E/e’ and PCWP despite no difference in cholesterol, BP and LV systolic function between the 2 groups. This suggested that pitavastatin may prevent LA remodeling and new-onset AF through the preservation of diastolic function in HTN.
Author Disclosures: M. Kawade: None. M. Kawasaki: None. R. Tanaka: None. S. Minatoguchi: None. K. Ono: None. M. Kaneda: None. M. Ishiguro: None. R. Matsuoka: None. H. Miwa: None. S. Warita: None. S. Tanihata: None. M. Arai: None. T. Noda: None. S. Watanabe: None. S. Minatoguchi: None.
- © 2014 by American Heart Association, Inc.