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Prognostic significance of left ventricular diastolic dysfunction in essential hypertension
Giuseppe Schillaci1, Leonella Pasqualini, Paolo Verdecchia
1Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
Insights
Essential hypertension patients with impaired left ventricular (LV) diastolic function face higher cardiovascular risk. Early detection via Doppler echocardiography aids risk stratification, independent of other factors.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Left ventricular (LV) diastolic dysfunction is common in hypertension, even without LV hypertrophy.
- The prognostic significance of diastolic alterations in hypertensive patients remains understudied.
Purpose of the Study:
- To evaluate the prognostic value of left ventricular diastolic function in essential hypertension.
- To determine if Doppler echocardiography can identify hypertensive individuals at increased cardiovascular risk.
Main Methods:
- Prospective follow-up of 1,839 hypertensive patients (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale study).
- Assessment of early/atrial (E/A) mitral flow velocity ratio, adjusted for age and heart rate (HR), via Doppler echocardiography.
- Analysis included 24-hour blood pressure monitoring and baseline cardiovascular risk factors.
Main Results:
- 164 major cardiovascular events occurred during a mean 4.4-year follow-up.
- A low age- and HR-adjusted E/A ratio was associated with a significantly higher incidence of cardiovascular events (p < 0.005).
- Cox analysis revealed that a low E/A ratio independently predicted increased cardiovascular risk (OR 1.57, p < 0.01).
Conclusions:
- Impaired LV early diastolic relaxation, identified by Doppler echocardiography, signifies elevated cardiovascular risk in hypertensive patients.
- This association is independent of LV mass and ambulatory blood pressure.
- Doppler-derived diastolic function assessment is a valuable tool for cardiovascular risk stratification in hypertension.
Objectives:
We sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension.
Background:
Alterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated.
Methods:
In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.4 years), 1,839 Caucasian hypertensive patients (50 +/- 12 years, 53% men, blood pressure (BP) 156/98 mm Hg) without previous cardiovascular events, who underwent Doppler echocardiography and 24-h BP monitoring before therapy. The early/atrial (E/A) mitral flow velocity ratio was calculated and corrected for age and heart rate (HR).
Results:
During follow-up, there were 164 major cardiovascular events (2.04 per 100 patient-years). The incidence of cardiovascular events was 2.47 and 1.65 per 100 patient-years in patients with an age- and HR-adjusted E/A ratio below (n = 919) and above (n = 920) the median value, respectively (p < 0.005 by the log-rank test). In Cox analysis, controlling for age, gender, diabetes, cholesterol, smoking, LV mass and 24-h systolic BP (all p < 0.05), a low age- and HR-adjusted E/A ratio conferred an increased risk of cardiovascular events (odds ratio 1.57, 95% confidence interval [CI] 1.11 to 2.18, p < 0.01). A 21% excess risk was found for each 0.3 decrease of the adjusted E/A ratio (95% CI from +2% to +43%; p = 0.03).
Conclusions:
Impaired LV early diastolic relaxation, detected by pulsed Doppler echocardiography, identifies hypertensive patients at increased cardiovascular risk. Such association is independent of LV mass and ambulatory BP.