Chinali Marcello, Aurigemma Gerard P, de Simone Giovanni, Mishra Rakesh K, Gerdts Eva, Wachtell Kristian, Boman Kurt, Dahlöf Björn, Devereux Richard B
University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Am J Cardiol. 2009 Oct 15;104(8):1098-104. doi: 10.1016/j.amjcard.2009.05.063.
The early mitral flow deceleration time (DTE) is a prognostically validated marker of left ventricular diastolic dysfunction. It has been reported that the DTE is influenced by the loading conditions, which can vary during antihypertensive treatment. We hypothesized that normalization of the DTE for mitral peak E-velocity (mitral deceleration index [MDI]) might better predict incident cardiovascular (CV) events in hypertensive patients during treatment compared to DTE alone or other traditional indexes of diastolic function, such as the mitral E/A ratio. We evaluated 770 hypertensive patients with electrocardiogram findings of left ventricular hypertrophy (age 66 +/- 7 years; 42% women) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic substudy. Echocardiographic examinations were performed annually for 5 years during intensive antihypertensive treatment. We examined the utility of the MDI at baseline and as a time-varying predictor of incident CV events. Of the 770 patients, 70 (9%) had CV events. The baseline MDI was positively associated with age and relative wall thickness and negatively associated with gender and heart rate (all p <0.01). Unadjusted Cox regression analysis showed a positive association between the baseline MDI and CV events (hazard ratio 1.21, 95% confidence interval 1.07 to 1.37, p = 0.002). In the time-varied Cox models, a greater in-treatment MDI was associated with a greater rate of CV events (hazard ratio 1.43, 95% confidence interval 1.05 to 1.93, p = 0.022), independently of the covariates. No significant association was found for in-treatment DTE or any of the prognostically validated indexes of diastolic function. In conclusion, in our population of patients with treated hypertension with electrocardiographic findings of left ventricular hypertrophy, the MDI independently predicted future CV events. Normalization of DTE for E velocity might be preferred to other traditional diastolic function indexes in evaluating diastolic function during antihypertensive treatment.
早期二尖瓣血流减速时间（DTE）是经预后验证的左心室舒张功能障碍标志物。据报道，DTE受负荷条件影响，而负荷条件在降压治疗期间可能会发生变化。我们假设，二尖瓣E峰速度校正后的DTE（二尖瓣减速指数[MDI]）相比于单独的DTE或其他传统舒张功能指标（如二尖瓣E/A比值），可能能更好地预测高血压患者治疗期间发生心血管（CV）事件的风险。我们评估了770例有左心室肥厚心电图表现的高血压患者（年龄66±7岁；42%为女性），这些患者参加了氯沙坦干预降低高血压终点事件（LIFE）超声心动图亚研究。在强化降压治疗期间，每年进行一次超声心动图检查，持续5年。我们研究了基线时MDI的效用以及作为CV事件发生风险的时变预测指标的效用。在这770例患者中，70例（9%）发生了CV事件。基线MDI与年龄和相对室壁厚度呈正相关，与性别和心率呈负相关（均p<0.01）。未经调整的Cox回归分析显示基线MDI与CV事件之间存在正相关（风险比1.21，95%置信区间1.07至1.37，p = 0.002）。在时变Cox模型中，治疗期间较高的MDI与较高的CV事件发生率相关（风险比1.43，95%置信区间1.05至1.93，p = 0.022），且独立于协变量。未发现治疗期间的DTE或任何经预后验证的舒张功能指标存在显著相关性。总之，在我们这群有左心室肥厚心电图表现的高血压治疗患者中，MDI可独立预测未来CV事件。在评估降压治疗期间的舒张功能时，E峰速度校正后的DTE可能比其他传统舒张功能指标更具优势。
