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Noninvasive assessment of left-ventricular diastolic electromechanical coupling in hypertensive heart disease
Yuko Saito1, Hirotsugu Yamada2,3, Kenya Kusunose1
1Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Insights
Noninvasive assessment of diastolic electromechanical coupling using electrocardiography and Doppler echocardiography can help stratify hypertensive patients at risk for heart failure. Elevated E/e
Area of Science:
- Cardiology
- Electrophysiology
- Echocardiography
- Hypertension Research
Background:
- The growing prevalence of heart failure necessitates improved patient risk stratification strategies.
- Hypertension is a major risk factor for developing heart failure, highlighting the need for early detection of at-risk individuals.
- Current methods for predicting heart failure development in hypertensive patients require enhancement.
Purpose of the Study:
- To investigate the clinical utility of noninvasively assessing diastolic electromechanical coupling in hypertensive patients.
- To determine if electrocardiography (ECG) and Doppler echocardiography parameters can predict heart failure development.
- To evaluate the relationship between electrophysiological and mechanical parameters of diastolic function for risk stratification.
Main Methods:
- Studied 109 hypertensive patients, measuring the time from peak to end of the T wave (TpTe) as an electrophysiological parameter.
- Measured peak early diastolic mitral flow (E) and lateral annular (e') velocities as mechanical parameters using Doppler echocardiography.
- Assessed the correlation between TpTe, E, e', and E/e', and their association with cardiovascular event prognosis.
Main Results:
- A significant inverse correlation was found between e' and TpTe (p < 0.001), and a positive correlation between E/e' and TpTe (p < 0.001).
- The E/e' ratio was a significant predictor of cardiovascular events (p = 0.003), with higher E/e' indicating worse outcomes.
- While TpTe correlated with diastolic parameters, it did not independently predict outcomes in this cohort.
Conclusions:
- The correlation between TpTe and echocardiographic parameters (e', E/e') suggests they reflect diastolic ventricular electromechanical coupling.
- Elevated E/e' is a significant predictor of adverse cardiovascular outcomes in hypertensive patients.
- Noninvasive assessment of diastolic electromechanical coupling, particularly E/e', is clinically valuable for predicting prognosis in hypertension.
Background:
There is a need to stratify patients who may develop heart failure because of the current "heart failure pandemic". We hypothesized that noninvasive assessment of diastolic electromechanical coupling by electrocardiography and Doppler echocardiography may be clinically useful for risk stratification of hypertensive patients who may develop heart failure.
Methods:
We measured the time from the peak to end of the T wave (TpTe) as an electrophysiological parameter, and peak early diastolic mitral flow (E) and lateral annular (e') velocities as mechanical parameters in 109 patients with hypertension. Relationships between these parameters and their association with the prognosis were evaluated.
Results:
The e' was inversely correlated with TpTe (p < 0.001) and QTc (p < 0.014), whereas E/e' was positively correlated with TpTe (p < 0.001) and QTc (p < 0.001). The TpTe predicted patients with E/e' > 12. There were 24 cardiovascular events during follow-up (57 ± 20 months), and Kaplan-Meier analysis showed that outcome was worse (p = 0.003) in patients with higher E/e' than lower E/e'; however, there was no difference between patients with longer TpTe (≧72 ms) and shorter TpTe (< 72 ms).
Conclusion:
The correlation of TpTe with e' and E/e' in hypertensive patients suggests that these parameters reflect diastolic ventricular electromechanical coupling. The E/e' predicted outcome, and an elevated E/e' should be suspected when TpTe is prolonged (> 72 ms). Noninvasive evaluation of diastolic electromechanical coupling is clinically useful in patients with hypertension for predicting their outcome.
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