ABSTRACT
INTRODUCTION: LV dysfunction develops early in hypertension, even previously to left ventricular remodeling. AIMS: To determine the frequency of morphologic and functional heart abnormalities associated to abnormal modified Tei Index in untreated hypertensive (HBP) patients (p) with preserved ejection fraction (pEF). METHODS: Case-control study. Three groups: (1) HBP without left ventricular hypertrophy (LVH); (2) HBP with LVH; (3) non-HBP controls. Ejection fraction >54 % identified pEF. LVH measured by Devereux method. Systolic and diastolic functions assessed by standard echocardiography and tissue Doppler. 2013 ESH/ESC Hypertension Guidelines normal values were considered. Tei index measured at the lateral and septal LV walls in apical 4-chamber view by tissue Doppler, value >0.40 considered abnormal. STATISTICAL ANALYSIS: multifactorial ANOVA test adjusted by sex and age, p < 0.05 statistically significant. RESULTS: The study included 14 controls, 88 HBP p without LVH, and 19 HBP p with LVH. The HBP p sample mean age was 58.7 ± 13.5 years and 52 (44.1 %) were males. Mean Tei Index was 0.35 ± 0.03 in controls; 0.42 ± 0.05 in HBP without LVH; and 0.42 ± 0.06 in HBP with LVH (p < 0.025). Abnormal Tei Index was present in 2p (14.3 %) controls; 64 p (72.7 %) HBP without LVH; and 15 p (78.9 %) HBP with LVH (p < 0.0009). Tissue Doppler's wave was 8.4 ± 0.9 cm/s in controls; 8 ± 1.6 cm/s in HBP without LVH and 7.8 ± 1.1 cm/s in HBP with LVH. CONCLUSIONS: (1) Left ventricular dysfunction is frequent in HBP p, even without LVH; (2) modified tissue Doppler Tei index is a useful tool for the diagnosis of left ventricular dysfunction.
Subject(s)
Blood Pressure , Hypertension/complications , Hypertrophy, Left Ventricular/etiology , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left , Ventricular Remodeling , Adult , Aged , Case-Control Studies , Cross-Sectional Studies , Echocardiography, Doppler, Color , Female , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Risk Factors , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Background: Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. Objective: To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. Methods: Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95 g/m2 in women and >115 g/m2 in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). Results: A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of < 10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p < 0.05), abnormal E/e′ ratio was found in 13.8%, 31.1% and 27.9%, respectively (p < 0.05). Mean s wave was 8.03 + 8, 8.1 + 9 and 8.7 + 1 cm/s for low, intermediate and high risk patients, respectively (p < 0.025). Conclusions: Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage
Antecedentes: Las tablas de riesgo cardiovascular dirigen el tratamiento según marcadores clínicos sencillos. Muchos algoritmos no recomiendan el cribado rutinario del daño de órgano blanco asintomático que podría cambiar drásticamente la estratificación. Objetivos: Demostrar que el daño en órgano blanco es altamente prevalente en el bajo riesgo cardiovascular y más frecuente y severo en la medida en que este aumenta. Material y métodos: Un total de 292 pacientes hipertensos consecutivos no tratados en un único centro latinoamericano. Riesgo cardiovascular estratificado según Guía 2013 OMS/ISH América B. Masa ventricular izquierda evaluada por método de Devereux, hipertrofia ventricular izquierda >95 g/m2 mujeres y >115 g/m2hombres. Se midió relación velocidad pico diastólico transmitral con doppler y velocidad diastólica precoz septal y lateral del anillo mitral con doppler tisular (relación E/e′), valor de corte >13. Función sistólica evaluada por doppler tisular como tasa de excursión tabique interventricular y pared lateral (onda s). Resultados: Un total de 159 pacientes (54,5%) presentaron riesgo cardiovascular <10%; 90 (30,8%) riesgo cardiovascular entre el 10% y el <20% y 43 (14,7%) presentaron un riesgo cardiovascular >20%. La hipertrofia ventricular izquierda en 17,6% pacientes fue de bajo riesgo, en el 27,8% de riesgo intermedio y en el 23,3% de alto riesgo (p < 0,05), con relación E/e′ anormal 13,8; 31,1 y 27,9%, respectivamente (p < 0,05). La onda s promedio fue de 8,03 + 8; 8,1 + 9 ; y 8,7 + 1 cm/seg para riesgo bajo, intermedio y alto, respectivamente (p < 0,025). Conclusiones: El daño en órgano blanco fue más frecuente y severo en alto riesgo; uno de cada 4 sujetos fue clasificado erróneamente debido a presencia de daño en órgano blanco subclínico
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Hypertrophy, Left Ventricular/prevention & control , Ventricular Dysfunction, Left/prevention & control , Hypertension/prevention & control , Risk Factors , Risk Adjustment/classificationABSTRACT
BACKGROUND: Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. OBJECTIVE: To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. METHODS: Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). RESULTS: A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of <10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025). CONCLUSIONS: Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage.
Subject(s)
Cardiovascular Diseases/epidemiology , Hypertrophy, Left Ventricular , Diastole , Echocardiography, Doppler , Female , Humans , Male , Risk Factors , Systole , Ventricular Dysfunction, Left/diagnosis , Ventricular Function, Left , World Health OrganizationABSTRACT
Introducción: El diagnóstico de hipertrofia ventricular izquierda (HVI) está basado en consensos. Objetivo: Determinar la relevancia de los cambios en los criterios de las guías ESH/ESC 2007 vs. 2013. Material y métodos: Ecocardiograma 2D y M; concordancia del índice de masa ventricular izquierda (IMVI) entre ESH/ESC 2007 y 2013. Análisis estadístico: Test de t de Student. Razón y coeficiente de correlación intraclase. Significación estadística p < 0,05. Resultados: Un total de 503 pacientes, con IMVI promedio ESH/ESC 2007 101 + 21,8 g/m2 vs ESH/ESC 2013 88 + 17,6 g/m2 (p < 0,001). Coeficiente de correlación r = 0,856 (p < 0,0005), razón 0,88 + 0,3. Frecuencia de HVI ESH/ESC 2007 23,9% vs ESH/ESC 2013 20,3% (p = NS). ESH/ESC 2007 y 2013 coincidieron en el diagnóstico en 94,4%. Conclusiones: 1) El IMVI es un 12% menor con la guía ESH/ESC 2013; 2) el diagnóstico es concordante en el 94,4% de los casos
Introduction: The diagnosis of left ventricular hypertrophy (LVH) is consensus based. Objective: To determine the relevance of the changes in criteria from the 2007 to 2013 ESH/ESC. Material and methods: A 2D and M echocardiography. The concordance index between the 2007 and 2013 ESH/ESC for left ventricular mass index (LVMI) was analyzed. Statistical análisis: Student t test. Intraclass correlation ratio and coefficient. Statistical significance P < .05. Results: A total of 503 patients, with mean LVMI ESH/ESC 2007 101 + 21.8 g/m2 and ESH/ESC 2013 88.8 + 17.6 g/m2 (P < .001). Correlation coefficient r = .856 (P < .0005) and ratio 0.88 + 0.3. 2007ESH/ESC LVH was 23.9% and 2013 ESH/ESC 20.3% (p = NS). The 2007 and 2013 ESH/ESC measurements coincided in 94.4% of the diagnoses. Conclusions: 1) On an average, LVMI was 12% less with the 2013 ESH/ESC Guidelines. 2) The diagnosis is in agreement between the guidelines in 94.4% of cases
