TY - JOUR
T1 - In-treatment midwall and endocardial fractional shortening predict cardiovascular outcome in hypertensive patients with preserved baseline systolic ventricular function
T2 - The Losartan Intervention for Endpoint reduction study
AU - Wachtell, Kristian
AU - Gerdts, Eva
AU - Palmieri, Vittorio
AU - Olsen, Michael H.
AU - Nieminen, Markku S.
AU - Papademetriou, Vasilios
AU - Boman, Kurt
AU - Dahlöf, Björn
AU - Aurigemma, Gerard P.
AU - Rokkedal, Jens E.
AU - Devereux, Richard B.
PY - 2010/7/1
Y1 - 2010/7/1
N2 - Background: Endocardial fractional shortening (EFS) and midwall shortening (MWS) are impaired in patients with left ventricular hypertrophy. However, it remains unknown whether improvement of left ventricular systolic function during treatment reduces cardiovascular morbidity and mortality in hypertensive patients with preserved left ventricular function. Methods: Echocardiograms were performed yearly in 840 hypertensive patients with electrocardiographic left ventricular hypertrophy and baseline left ventricular ejection fraction more and equal to 50%. Baseline and annual in-treatment levels of EFS, MWS and blood pressure (BP) were related to occurrence of a composite endpoint (cardiovascular death, myocardial infarction or stroke) and the component endpoints during 3914 patient-years of follow-up. Results: Adjusting for in-treatment BP, left ventricular mass, relative wall thickness and randomized treatments, higher in-treatment EFS was associated with lower risk of myocardial infarction (by 35% per standard deviation [4.5%], P = 0.004) and heart failure (49%, P < 0.001), but in-treatment stress-corrected EFS predicted only incident heart failure (41%, P = 0.014) but not other endpoints. Higher in-treatment MWS tended to be associated with lower risk of composite endpoints (16% per standard deviation [1.8%], P = 0.07) and was significantly associated with myocardial infarction (33%, P = 0.004) and heart failure (43%, P < 0.001). Higher in-treatment stress-corrected MWS was associated with lower rates of myocardial infarction (35%, P = 0.021) and heart failure (50%, P = 0.001). Conclusion: These results support a prognostic role for left ventricular myocardial function, as estimated by stress-corrected MWS, during aggressive BP lowering in hypertensive patients with preserved ejection fraction at baseline evaluation.
AB - Background: Endocardial fractional shortening (EFS) and midwall shortening (MWS) are impaired in patients with left ventricular hypertrophy. However, it remains unknown whether improvement of left ventricular systolic function during treatment reduces cardiovascular morbidity and mortality in hypertensive patients with preserved left ventricular function. Methods: Echocardiograms were performed yearly in 840 hypertensive patients with electrocardiographic left ventricular hypertrophy and baseline left ventricular ejection fraction more and equal to 50%. Baseline and annual in-treatment levels of EFS, MWS and blood pressure (BP) were related to occurrence of a composite endpoint (cardiovascular death, myocardial infarction or stroke) and the component endpoints during 3914 patient-years of follow-up. Results: Adjusting for in-treatment BP, left ventricular mass, relative wall thickness and randomized treatments, higher in-treatment EFS was associated with lower risk of myocardial infarction (by 35% per standard deviation [4.5%], P = 0.004) and heart failure (49%, P < 0.001), but in-treatment stress-corrected EFS predicted only incident heart failure (41%, P = 0.014) but not other endpoints. Higher in-treatment MWS tended to be associated with lower risk of composite endpoints (16% per standard deviation [1.8%], P = 0.07) and was significantly associated with myocardial infarction (33%, P = 0.004) and heart failure (43%, P < 0.001). Higher in-treatment stress-corrected MWS was associated with lower rates of myocardial infarction (35%, P = 0.021) and heart failure (50%, P = 0.001). Conclusion: These results support a prognostic role for left ventricular myocardial function, as estimated by stress-corrected MWS, during aggressive BP lowering in hypertensive patients with preserved ejection fraction at baseline evaluation.
KW - left ventricular hypertrophy
KW - mortality
KW - systolic performance
UR - http://www.scopus.com/inward/record.url?scp=77954387103&partnerID=8YFLogxK
U2 - 10.1097/HJH.0b013e328339f943
DO - 10.1097/HJH.0b013e328339f943
M3 - Article
C2 - 20410835
AN - SCOPUS:77954387103
SN - 0263-6352
VL - 28
SP - 1541
EP - 1546
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 7
ER -