Echocardiography Predictors of Survival in Hypertensive Patients With Left Ventricular Hypertrophy
Bartlomiej M Guzik1,2, Linsay McCallum1, Krzysztof Zmudka2
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Insights
Left ventricular hypertrophy (LVH) risk stratification requires tailored echocardiographic measures. Concentric LVH predicts worse cardiovascular outcomes than eccentric LVH in hypertensive patients.
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) is a recognized target organ damage in cardiovascular disease.
- Concentric hypertrophy is a strong predictor of cardiovascular events, yet individual echocardiographic parameters' predictive value is unclear.
Purpose of the Study:
- To identify echocardiographic and hemodynamic variables linked to concentric and eccentric left ventricular remodeling.
- To assess the association of these variables with long-term cardiovascular outcomes.
Main Methods:
- Analysis of echocardiography data from 690 patients within one year of clinic visit.
- Application of logistic regression, multivariable Cox-proportional hazards models, and cubic spline interpolation.
- 10-year follow-up for major adverse cardiac and cerebrovascular events (MACCE) and mortality.
Main Results:
- Concentric LVH demonstrated worse outcomes compared to eccentric LVH in hypertensive individuals over 10 years.
- Relative wall thickness linearly predicted all-cause mortality (ACM) and composite endpoints in concentric hypertrophy.
- Systolic blood pressure and blood pressure variability were significant predictors of MACCE and ACM.
Conclusions:
- Risk stratification for LVH necessitates distinct echocardiographic measures based on remodeling type.
- Tailoring risk assessment to concentric versus eccentric hypertrophy improves outcome prediction.
Background:
Left ventricular hypertrophy (LVH) is a well-known target organ damage. Concentric hypertrophy is the strongest predictor of increased risk of cardiovascular events, but the predictive value of individual echocardiographic parameters remains unclear.The aim of this study was to search for echocardiographic and hemodynamic variables associated with concentric and eccentric remodeling and their association with long-term cardiovascular outcomes.
Methods:
Patients with echocardiography performed within 1 year prior to the initial clinic visit were included into the study. Logistic regression and multivariable Cox-proportional hazards were calculated according to several risk factors and variables. Additionally, cubic spline interpolation was used.
Results:
We observed 690 patients for 10 years. There was a total of 177 major adverse cardiac and cerebrovascular events (MACCE) and 90 deaths over a 10-year period. Left ventricular concentric hypertrophy is associated with worse outcomes than eccentric hypertrophy in hypertensive subjects. Interestingly, different echocardiographic parameters contributed to risk depending on type of hypertrophy. In concentric hypertrophy, relative wall thickness provides linear prediction of risk for all-cause mortality (ACM) and composite endpoint. Systolic blood pressure is a significant predictor of MACCE. Blood pressure variability also showed significant predictive value for MACCE and ACM.
Conclusions:
These data indicate risk stratification based on LVH need to consider different measures based on the type of remodeling.
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