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Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive
Enayet K Chowdhury1, Garry L R Jennings2, Elizabeth Dewar2
1Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; enayet.chowdhury@monash.edu.
Insights
Left ventricular hypertrophy (LVH) assessed by echocardiography predicts cardiovascular events in elderly hypertensive patients. The LVH-BSA(115/95) definition reliably identifies high-risk individuals for future cardiovascular outcomes.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Hypertension causes cardiac changes detectable by echocardiography.
- Assessing left ventricular hypertrophy (LVH) is crucial for predicting cardiovascular risk in hypertensive patients.
- This study focuses on elderly hypertensive individuals without heart failure.
Purpose of the Study:
- To evaluate the predictive performance of echocardiographic parameters for cardiovascular outcomes.
- To specifically assess the role of left ventricular hypertrophy (LVH) in elderly hypertensive patients.
- To compare different LVH definitions for their predictive accuracy.
Main Methods:
- Utilized data from the Second Australian National Blood Pressure trial (LVH substudy).
- Echocardiograms were performed at baseline in 666 participants aged ≥65 years.
- Defined LVH using specific thresholds for left ventricular mass (LVM) indexed to body surface area (BSA) or height(2.7).
Main Results:
- LVH prevalence varied from 33% to 70% based on definition.
- Only LVH-BSA(115/95) significantly predicted both short- and long-term cardiovascular outcomes after risk factor adjustment.
- Patients with LVH-BSA(115/95) had a doubled risk of cardiovascular events (short-term) and fatal events (long-term).
Conclusions:
- Echocardiographic LVH assessment in elderly hypertensives is definition-dependent.
- The LVH-BSA(115/95) definition is a reliable predictor of future cardiovascular events in this population.
- This finding aids in risk stratification for elderly hypertensive patients.
Background:
Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure.
Methods:
Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height(2.7): >115/95g/m(2) (LVH-BSA(115/95)) or ≥49/45g/m(2.7) (LVH-ht(49/45)) in males/females, respectively, and ≥125g/m(2) (LVH-BSA(125)) or ≥51g/m(2.7) (LVH-ht(51)) for both sexes.
Results:
In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%-70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA(115/95) predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA(115/95) (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12-3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21-3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height(2.7) predicted cardiovascular events over both short and longer term.
Conclusions:
In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA(115/95) is a reliable predictor of future cardiovascular outcomes in the elderly.
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