Pulmonary venous flow and risk of cardiovascular disease in essential hypertension

The prognostic significance of the pulmonary venous flow in essential hypertensive patients was investigated.

Doppler transthoracic echocardiograms were analyzed in 705 essential hypertensive subjects with no prior cardiovascular disease. At baseline, most subjects had 'normal diastolic function' or 'mild diastolic dysfunction'. During follow-up (mean, 32 months), 56 participants developed cardiovascular disease. Sex-specific median values were used to separate the higher group from the lower group of the peak velocity ratio of the pulmonary venous systolic to diastolic wave (S/D) (male < 1.51, female < 1.66), and of the transmitral velocity ratio of early diastolic to atrial filling (E/A) (male < 0.84, female < 0.82). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the groups with high S/D (P < 0.01) and low E/A (P < 0.01), respectively. In multivariate Cox regression analysis, the S/D ratio (HR 1.07 for each 0.1 increase, P = 0.03) or E/A ratio (P < 0.01) was an independent predictor of cardiovascular disease events. When divided into four groups based on the respective sex-specific median levels of S/D in the E/A > or = median and E/A < median groups, the group with high S/D and low E/A (S/D; male > or = 1.77, female > or = 1.81) had a significantly poorer event-free survival rate (chi2 = 28.06, P < 0.01), and the adjusted-hazard ratio by multivariate Cox regression analysis was 2.16 (95% CI; 1.40-3.07, P < 0.01).

Increased S/D or decreased E/A is associated with an increased cardiovascular disease risk, and the combination of high S/D and low E/A may be a powerful predictor of cardiovascular disease in essential hypertension. Pulmonary venous flow evaluation may provide clinically important prognostic information in patients with essential hypertension.