Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, 00, Hong Kong
Journal of Hypertension (Impact Factor: 4.22). 01/2005; 23(1):183-91. DOI: 10.1097/00004872-200501000-00029
Source: PubMed

ABSTRACT We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy.
Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients.
Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months.
Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043).
Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.

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    • "It also appears that diastolic function evaluated by TDI may be impaired in hypertensive subjects in the absence of LV hypertrophy (Müller-Brunotte et al., 2007; Tsilakis et al., 2008; Narayanan et al., 2009). In addition, impaired systolic and diastolic function measured by TDI is a strong individual predictor of adverse clinical outcome in patients with hypertension and preserved LV ejection fraction (Wang et al., 2005; Yu et al., 2007). A healthy lifestyle with regular physical exercise is recommended as part of the non-pharmacological treatment of hypertension (Cornelissen & Fagard, 2005; Fagard & Cornelissen, 2007; Mancia et al., 2007; Cornelissen et al., 2010). "
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    • "Specifically, Wang et al. reported that e < 3 cm/s was a powerful predictor for cardiac death in patients with reduced (<50%) EF [8]. Similarly, the same group reported the predictive value of e < 3.5 cm/s for cardiac death in hypertensive subjects with LV hypertrophy [9]. These results suggest that the best cut-off point of e for the prediction of adverse prognosis may be variable depending on population studied. "
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