CLINICAL STUDY
Prognostic significance of left ventricular diastolic dysfunction in essential hypertension
Giuseppe Schillaci, MD*,*,
Leonella Pasqualini, MD*,
Paolo Verdecchia, MD, FACC ,
Gaetano Vaudo, MD*,
Simona Marchesi, MD*,
Carlo Porcellati, MD,
Giovanni de Simone, MD, FACC and
Elmo Mannarino, MD*
* 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.
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Abbreviations and Acronyms
| | BP | | blood pressure | | CI | | confidence interval | | E/A | | early/atrial velocity ratio | | HR | | heart rate | | LV | | left ventricular | | PIUMA | | Progetto Ipertensione Umbria Monitoraggio Ambulatoriale |
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