Cicala Silvana, de Simone Giovanni, Wachtell Kristian, Gerdts Eva, Boman Kurt, Nieminen Markku S, Dahlöf Björn, Devereux Richard B
Division of Cardiology, Weill Cornell Medical College, New York, New York 10021, USA.
J Hypertens. 2008 Apr;26(4):806-12. doi: 10.1097/HJH.0b013e3282f4b3a9.
Left ventricular systolic wall motion abnormalities have prognostic value. Whether wall motion detected by serial echocardiographic examinations predicts prognosis in hypertensive patients with left ventricular hypertrophy (LVH) without clinically recognized atherosclerotic disease has, however, never been investigated. We examined whether 'in-treatment' wall motion abnormalities predicted outcome in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension echocardiographic substudy.
We studied 749 patients without coronary artery disease, myocardial infarction (MI), or stroke history. Echocardiographic segmental wall motion abnormalities at baseline and annual re-evaluations ('as time-varying covariate') were examined in relation to endpoints (cardiovascular mortality, MI, stroke, and hospitalized heart failure). Adjusted Cox regression was used to analyze the primary composite endpoint of cardiovascular death, MI, or stroke and, separately, for fatal and nonfatal MI and hospitalized heart failure.
During a mean follow-up of 4.8 years, an event was recorded in 67 (9%) patients. In Cox models after adjusting for age, gender, treatment, blood pressure lowering, and serial change of left ventricular mass index, 'in-treatment' segmental wall motion abnormalities were associated with subsequent composite endpoint [hazard ratio = 2.1, 95% confidence interval (CI) 1.1-3.8; P = 0.019] and MI [hazard ratio = 3.7 (1.5-8.9); P = 0.004].
In hypertensive patients with LVH and no history of cardiovascular disease, 'in-treatment' left ventricular wall motion abnormalities are associated with increased likelihood of subsequent cardiovascular events independent of age, gender, blood pressure lowering, treatment modality, and in-treatment left ventricular mass index.
左心室收缩期壁运动异常具有预后价值。然而，通过系列超声心动图检查检测到的壁运动能否预测无临床公认动脉粥样硬化疾病的高血压左心室肥厚（LVH）患者的预后，此前从未被研究过。我们在氯沙坦干预降低终点事件（LIFE）高血压超声心动图亚研究中，检验了“治疗期间”的壁运动异常是否能预测预后。
我们研究了749例无冠心病、心肌梗死（MI）或中风病史的患者。在基线和每年重新评估时（作为“随时间变化的协变量”）的超声心动图节段性壁运动异常与终点事件（心血管死亡、MI、中风和住院心力衰竭）进行关联分析。采用校正后的Cox回归分析心血管死亡、MI或中风的主要复合终点，以及分别分析致命性和非致命性MI和住院心力衰竭。
在平均4.8年的随访期间，67例（9%）患者记录到事件。在调整年龄、性别、治疗、血压降低和左心室质量指数的系列变化后的Cox模型中，“治疗期间”的节段性壁运动异常与随后的复合终点相关[风险比=2.1，95%置信区间（CI）1.1 - 3.8；P = 0.019]和MI[风险比=3.7（1.5 - 8.9）；P = 0.004]。
在无心血管疾病史的LVH高血压患者中，“治疗期间”的左心室壁运动异常与随后心血管事件发生的可能性增加相关，且独立于年龄、性别、血压降低、治疗方式和治疗期间的左心室质量指数。
