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Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment
M L Muiesan1, M Salvetti, D Rizzoni
1Cattedra di Semeiotica e Metodologia Medica, UOP Scienze Mediche, Università di Brescia, Italy.
Insights
Changes in left ventricular hypertrophy (LVH) impact cardiovascular events in hypertensive patients. Regression of LVH significantly reduces risk, while its persistence or development indicates a higher event rate.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Echocardiography
Background:
- Hypertension frequently leads to left ventricular hypertrophy (LVH).
- The prognostic significance of LVH changes over time in hypertensive individuals requires further elucidation.
- Assessing LVH regression or progression is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To evaluate the prognostic value of changes in left ventricular hypertrophy (LVH) over time in patients with hypertension.
- To determine the association between LVH regression, persistence, or development and the incidence of non-fatal cardiovascular events.
Main Methods:
- Baseline and follow-up echocardiograms were performed on 215 and 151 hypertensive patients, respectively, over a mean of 10 years.
- Left ventricular mass index (LVMI) changes were analyzed.
- Cox survival analysis was used to assess the relationship between LVH status and cardiovascular events, adjusted for risk factors.
Main Results:
- Patients were categorized into four groups based on LVH status: normal LVMI (n=78), regression (n=32), persistence (n=34), and development (n=7).
- The cumulative incidence of non-fatal cardiovascular events was significantly higher in patients without LVH regression.
- Persistence of LVH at follow-up was the strongest predictor of cardiovascular events.
Conclusions:
- Lack of LVH decrease or increase in left ventricular mass after antihypertensive treatment is linked to elevated cardiovascular event risk.
- Complete regression of LVH significantly reduces cardiovascular risk, approaching normalization.
- Monitoring and achieving LVH regression are vital in managing hypertensive patients.
Objective:
The aim of the present study was to assess the prognostic value of changes in left ventricular hypertrophy in hypertensive patients with time.
Design:
Two hundred and fifteen uncomplicated hypertensive patients underwent a high-quality baseline echocardiogram for left ventricular anatomy evaluation and in 151 of those patients the echocardiographic examination was repeated 10 +/- 1.4 years after the initial study.
Methods:
Left ventricular mass index changes were evaluated, in relation to the incidence of non-fatal cardiovascular events, adjusted for traditional cardiovascular risk factors.
Results:
According to the presence or absence of left ventricular hypertrophy (left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women) at baseline and at the end of follow-up study, patients were divided into four groups: with normal left ventricular mass at both examinations (n = 78), with regression of left ventricular hypertrophy (n = 32), with persistence of left ventricular hypertrophy (n = 34) and with hypertrophy development (n = 7). After adjustment for traditional cardiovascular risk factors, the cumulative incidence of non-fatal cardiovascular events was significantly higher in the group of patients without regression of left ventricular hypertrophy. Cox survival analysis showed the presence of left ventricular hypertrophy at the end of follow-up study to be the most important factor related to cardiovascular events.
Conclusions:
The present findings strongly indicate that the lack of decrease or the increase of left ventricular mass after antihypertensive treatment can be associated with a higher risk for cardiovascular events, which is significantly reduced and almost normalized by complete regression of left ventricular hypertrophy.