Prognostic impact of impaired left ventricular midwall function during progression of aortic stenosis.

OBJECTIVE: In hypertension, indexes of midwall left ventricular (LV) function may identify patients at higher cardiovascular (CV) risk independent of normal LV ejection fraction (EF). We analyzed the association of baseline and new-onset LV midwall dysfunction with CV outcome in a large population of patients with asymptomatic aortic stenosis (AS). METHODS: One thousand four hundred seventy-eight patients with asymptomatic AS and normal EF (≥50%) at baseline in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study were followed for a median of 4.3 years. LV systolic function was assessed by biplane EF and midwall shortening (MWS, low if <14% in men/16% in women) at baseline and annual echocardiographic examinations. RESULTS: One hundred twenty-three CV deaths and heart failure hospitalizations occurred during follow-up. In Cox analyses, adjusting for age, gender, body mass index, hypertension, EF, AS severity, LV hypertrophy and systemic arterial compliance, low baseline MWS predicted 61% higher risk of a major CV event and a twofold higher risk of death and heart failure hospitalization (P < .05). New-onset low MWS developed in 574 patients, particularly in elderly women with higher blood pressure and more severe AS (P < .05). In time-varying Cox analysis, new-onset low MWS was associated with a twofold higher risk of CV death and heart failure hospitalization, independent of changes over time in EF, AS severity, LV hypertrophy and systemic arterial compliance (P < .05). CONCLUSIONS: Low MWS develops in a large proportion of patients with AS and normal EF during valve disease progression and is a marker of increased CV risk.

Target organ damage and masked hypertension in the general population: the Finn-Home study.

BACKGROUND: The relation of masked hypertension to target organ damage has very seldom been investigated in a general population. METHODS: An unselected population cohort (n = 1989 of which 1540 were not treated for hypertension) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) blood pressure (BP) measurements and evaluation of electrocardiographic left ventricular hypertrophy (ECG-LVH, n = 1989/1540), carotid intima-media thickness (cIMT, n = 758/592), and pulse wave velocity (PWV, n = 237/158). ECG-LVH was diagnosed using Cornell voltage criteria. PWV was measured using whole-body impedance cardiography. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg and white-coat hypertension as office BP at least 140/90 mmHg and home BP less than 135/85 mmHg. RESULTS: Masked and sustained hypertensive individuals had significantly higher age-adjusted and sex-adjusted Cornell voltage, cIMT, and PWV than normotensive individuals. White-coat hypertensive patients had higher age-adjusted and sex-adjusted Cornell voltage than normotensive individuals but significantly lower Cornell voltage and PWV than sustained hypertensive patients. The differences in Cornell voltage and PWV remained significant after adjustment for confounding factors. However, all differences became nonsignificant after adjustment for systolic home BP. CONCLUSION: Masked and sustained hypertension is accompanied by increased risk for hypertensive target organ damage, whereas white-coat hypertension seems to be a more benign phenomenon.

Sex differences in short- and long-term case-fatality of myocardial infarction.

Declining trends in case fatality (CF) of MI events have been generally reported in western countries. It is, however, not clear whether the development has been equally beneficial in both sexes. Data from two large population based registers, FINAMI and the Finnish National Cardiovascular Disease Register (CVDR) were used to determine whether the CF of incident MI events has declined less in women than in men. All patients aged 35 and over were included. CF was calculated for different time periods after the onset of the MI event, the main emphasis was in pre-hospital, 28-day, and 1-year CF. Figures were compared between two study periods: 1994-1996 and 2000-2002. A total of 6,342 incident MI events were recorded in FINAMI and 117,632 events in CVDR during the study periods. Comparison between the two study periods showed that the CF was generally declining. However, a slower decline in short-term CF was seen among young (aged<55 years) women (P for sex by study period interaction in pre-hospital CF=0.028 in FINAMI and 0.003 in CVDR, and for 28-day CF P=0.016 in FINAMI and <0.0001 in CVDR). In conclusion, the short and long-term prognosis of MI events has improved in both sexes. Pre-hospital CF has declined less among younger women than among men and among older women. This slower decline in early CF was responsible for the slower improvement in 28-day and 1-year prognosis in young women.