Carotid vascular strain predicts cardiovascular events in patients with hypertension
Wei-Chuan Tsai1,2, Wen-Huang Lee2, Huey-Ru Tsai2,3
1Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan.
Insights
Lower carotid strain (CS) and strain rate (CSR) predict cardiovascular events in hypertensive patients. These ultrasound measures offer prognostic insights for hypertension management.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Hypertension Research
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Assessing cardiovascular risk in hypertensive patients requires reliable prognostic markers.
- Carotid biomechanical properties, including strain and strain rate, may offer such markers.
Purpose of the Study:
- To investigate the prognostic significance of carotid strain (CS) and carotid strain rate (CSR) in patients with hypertension.
- To determine if CS and CSR are independent predictors of major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Prospective observational study of 120 hypertensive patients.
- Two-dimensional speckle tracking ultrasound was used to measure peak circumferential CS and peak CSR.
- Major cardiovascular events were tracked over a mean follow-up of 63.6 months.
Main Results:
- 14% of patients experienced cardiovascular events (stroke, acute coronary syndrome, heart failure).
- Lower CS and CSR were significantly associated with increased cardiovascular event risk.
- Multivariate analysis confirmed CS and CSR as independent predictors of MACE, even after controlling for traditional risk factors.
Conclusions:
- Decreased CS and CSR are associated with a higher risk of cardiovascular events in hypertensive individuals.
- Carotid biomechanical parameters measured by ultrasound may enhance cardiovascular risk stratification in hypertension.
- These findings suggest a potential role for CS and CSR in guiding clinical management of hypertensive patients.
Background:
We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension.
Methods:
We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two-dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure.
Results:
After a mean follow-up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs 143.1 ± 16.6 mm Hg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs 82.1 ± 12.2 mm Hg; p = 0.039), use of diuretics (71 vs 92%; p = 0.014), carotid CS (2.17 ± 1.02 vs 3.28 ± 1.14 %; p = 0.001), and CSR (.28 ± .17 vs .51 ± .18 1/s; p < 0.001) were significantly different between the patients who did and did not reach the end-points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR .425, 95%CI .223-.811, p = 0.009) and CSR (HR .001, 95%CI .000-.072, p = 0.001) were independent predictors for cardiovascular events.
Conclusion:
In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension.
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