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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish
Fang-Fei Wei1, Wen-Yi Yang1, Lutgarde Thijs1
1Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
Insights
Ambulatory blood pressure (ABP) predicts diastolic left ventricular dysfunction better than conventional blood pressure (CBP) over time. Both masked and sustained hypertension equally harm diastolic function.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Longitudinal data comparing echocardiographic diastolic function and blood pressure (BP) in the general population is lacking.
- Conventional BP (CBP) and ambulatory BP (ABP) may have differential impacts on cardiac structure and function.
- Diastolic left ventricular dysfunction is a key indicator of cardiovascular health.
Purpose of the Study:
- To investigate the longitudinal associations between conventional (CBP) and ambulatory (ABP) blood pressure and diastolic left ventricular function.
- To compare the predictive value of CBP and ABP for changes in echocardiographic indices of diastolic function.
- To assess the impact of different hypertension types (sustained, masked, white-coat) on diastolic function.
Main Methods:
- A longitudinal study of 780 Flemish individuals (mean age 50.2 years, 51.7% women).
- Echocardiographic assessment of left atrial volume index (LAVI), transmitral flow (E), mitral annular velocity (e'), and E/e' ratio.
- Measurement of CBP and ABP, analyzed over a median follow-up of 9.6 years.
- Adjusted regression models and categorized analyses based on hypertension status.
Main Results:
- Higher systolic/diastolic ABP was associated with increased LAVI and E/e' ratio, whereas baseline CBP was not.
- Lower e' velocity was observed with higher diastolic CBP and ABP.
- Sustained hypertension and masked hypertension were linked to greater LAVI, higher E/e', and lower e' compared to normotension or white-coat hypertension.
Conclusions:
- Ambulatory blood pressure is a significant long-term predictor of diastolic left ventricular function, outperforming distant conventional BP measurements.
- Concurrent conventional BP also showed associations with diastolic function indices, but ABP demonstrated stronger predictive power.
- Masked hypertension and sustained hypertension pose equivalent risks for the deterioration of diastolic left ventricular function.
Background:
No longitudinal study compared associations of echocardiographic indexes of diastolic left ventricular function studies with conventional (CBP) and daytime ambulatory (ABP) blood pressure in the general population.
Methods And Results:
In 780 Flemish (mean age, 50.2 years; 51.7% women), we measured left atrial volume index (LAVI), peak velocities of the transmitral blood flow (E) and mitral annular movement (e') in early diastole and E/e' 9.6 years (median) after CBP and ABP. In adjusted models including CBP and ABP, we expressed associations per 10/5-mm Hg systolic/diastolic blood pressure increments. LAVI and E/e' were 0.65/0.40 mL/m2 and 0.17/0.09 greater with higher systolic/diastolic ABP (P≤0.028), but not with higher baseline CBP (P≥0.086). e' was lower (P≤0.032) with higher diastolic CBP (-0.09 cm/s) and ABP (-0.19 cm/s). When we substituted baseline CBP by CBP recorded concurrently with echocardiography, LAVI and E/e' remained 0.45/0.38 mL/m2 and 0.15/0.08 greater with baseline ABP (P≤0.036), while LAVI (+0.53 mL/m2) and E/e' (+0.19) were also greater (P<0.001) in relation to concurrent systolic CBP. In categorized analyses of baseline data, sustained hypertension or masked hypertension compared with normotension or white-coat hypertension was associated with greater LAVI (24.0 versus 22.6 mL/m2) and E/e' (7.35 versus 6.91) and lower e' (10.7 versus 11.6 cm/s; P≤0.006 for all) with no differences (P≥0.092) between normotension and white-coat hypertension or between masked hypertension and sustained hypertension.
Conclusions:
ABP is a long-term predictor of diastolic left ventricular function, statistically outperforming distant but not concurrent CBP. Masked hypertension and sustained hypertension carry equal risk for deterioration of diastolic left ventricular function.
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