|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2002; 39:2005-2011 © 2002 by the American College of Cardiology Foundation |
* Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
Department of Cardiology, Perugia General Hospital, Perugia, Italy
Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy
Manuscript received January 8, 2002; revised manuscript received February 22, 2002, accepted March 7, 2002.
* Reprint requests and correspondence: Dr. Giuseppe Schillaci, Unit of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and Experimental Medicine, University of Perugia Medical School, via Brunamonti, 51, 06122 Perugia, Italy.
skill{at}unipg.it
OBJECTIVES: We sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension.
BACKGROUND: Alterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated.
METHODS: In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.4 years), 1,839 Caucasian hypertensive patients (50 ± 12 years, 53% men, blood pressure (BP) 156/98 mm Hg) without previous cardiovascular events, who underwent Doppler echocardiography and 24-h BP monitoring before therapy. The early/atrial (E/A) mitral flow velocity ratio was calculated and corrected for age and heart rate (HR).
RESULTS: During follow-up, there were 164 major cardiovascular events (2.04 per 100 patient-years). The incidence of cardiovascular events was 2.47 and 1.65 per 100 patient-years in patients with an age- and HR-adjusted E/A ratio below (n = 919) and above (n = 920) the median value, respectively (p < 0.005 by the log-rank test). In Cox analysis, controlling for age, gender, diabetes, cholesterol, smoking, LV mass and 24-h systolic BP (all p < 0.05), a low age- and HR-adjusted E/A ratio conferred an increased risk of cardiovascular events (odds ratio 1.57, 95% confidence interval [CI] 1.11 to 2.18, p < 0.01). A 21% excess risk was found for each 0.3 decrease of the adjusted E/A ratio (95% CI from +2% to +43%; p = 0.03).
CONCLUSIONS: Impaired LV early diastolic relaxation, detected by pulsed Doppler echocardiography, identifies hypertensive patients at increased cardiovascular risk. Such association is independent of LV mass and ambulatory BP.
| ||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  H. Pavlopoulos, J. Grapsa, E. Stefanadi, V. Kamperidis, E. Philippou, D. Dawson, and P. Nihoyannopoulos The evolution of diastolic dysfunction in the hypertensive disease Eur J Echocardiogr, April 29, 2008; (2008) jen145v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Lopez, J. M. Castellano, A. Gonzalez, J. Barba, and J. Diez Association of Increased Plasma Cardiotrophin-1 With Inappropriate Left Ventricular Mass in Essential Hypertension Hypertension, November 1, 2007; 50(5): 977 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Kirkpatrick, M. A. Vannan, J. Narula, and R. M. Lang Echocardiography in Heart Failure: Applications, Utility, and New Horizons J. Am. Coll. Cardiol., July 31, 2007; 50(5): 381 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Ahmed, L. L. Clark, W. R. Pennington, C. S. Webb, D. D. Bonnema, A. H. Leonardi, C. D. McClure, F. G. Spinale, and M. R. Zile Matrix Metalloproteinases/Tissue Inhibitors of Metalloproteinases: Relationship Between Changes in Proteolytic Determinants of Matrix Composition and Structural, Functional, and Clinical Manifestations of Hypertensive Heart Disease Circulation, May 2, 2006; 113(17): 2089 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, M. Pirro, G. Pucci, M. R. Mannarino, F. Gemelli, D. Siepi, G. Vaudo, and E. Mannarino Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women Hypertension, May 1, 2006; 47(5): 881 - 886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Iwashima, T. Horio, K. Kamide, H. Rakugi, T. Ogihara, and Y. Kawano Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension Hypertension, February 1, 2006; 47(2): 195 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Eryonucu, N. Guler, U. Guntekin, and M. Tuncer Comparison of the Effects of Nitroglycerin and Nitroprusside on Transmitral Doppler Flow Parameters in Patients with Hypertensive Urgency Ann. Pharmacother., June 1, 2005; 39(6): 997 - 1001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. W. Nielsen, A. Sajedieh, F. Petersen, and J. Fischer Hansen Value of left ventricular filling parameters to predict mortality and functional class in patients with heart disease from the community Eur J Echocardiogr, March 1, 2005; 6(2): 85 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Waggoner Echocardiographic Assessment of Left Ventricular Structure in Hypertension and the Impact on Clinical Outcomes Journal of Diagnostic Medical Sonography, September 1, 2004; 20(5): 304 - 314. [Abstract] [PDF]
|
|
|
|
 |
|
 I N Alecrin, J M Aldrighi, M A Caldas, O C E Gebara, N H M Lopes, and J A F Ramires Acute and chronic effects of oestradiol on left ventricular diastolic function in hypertensive postmenopausal women with left ventricular diastolic dysfunction Heart, July 1, 2004; 90(7): 777 - 781. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Muiesan, M. Lupia, M. Salvetti, C. Grigoletto, N. Sonino, M. Boscaro, E. A. Rosei, F. Mantero, and F. Fallo Left ventricular structural and functional characteristics in Cushing's syndrome J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2275 - 2279. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
