Kim Hyue Mee, Hwang In-Chang, Choi Hong-Mi, Yoon Yeonyee Elizabeth, Cho Goo-Yeong
Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.
Front Cardiovasc Med. 2022 Dec 20;9:1082008. doi: 10.3389/fcvm.2022.1082008. eCollection 2022.
Left ventricular (LV) hypertrophy (LVH) in patients with hypertension is a significant risk factor for cardiovascular mortality and morbidity. However, the prognostic implication of LVH regression after antihypertensive therapy has not been clearly investigated.
Patients who underwent echocardiography at the time of the diagnosis of hypertension and repeated echocardiography at an interval of 6-18 months were retrospectively identified. LVH was defined as LV mass index (LVMI) >115 g/m (men) and >95 g/m (women). LVH regression was defined as LVH at initial echocardiography with normal geometry or concentric LV remodeling at follow-up echocardiography. Cardiovascular mortality, hospitalization for heart failure (HHF), coronary revascularization, stroke, and aortic events were analyzed according to changes in LVMI and geometry.
Of 1,872 patients, 44.7% ( = 837) had LVH at the time of diagnosis; among these, 30.7% showed LVH regression. The reduction in LVMI was associated with the reduction in BP, especially in those with LVH at baseline. During follow up (median, 50.4 months; interquartile range, 24.9-103.2 months), 68 patients died of cardiovascular causes, 127 had HHF, and 162 had vascular events (coronary revascularization, stroke, and aortic events). Persistent or newly developed LVH during antihypertensive therapy was a significant predictor of cardiovascular mortality and events, especially HHF. On multivariable analysis, women, diabetes, atrial fibrillation, coronary artery disease, larger LVMI and end-diastolic dimension, and less reduction in systolic BP were associated with persistent or newly developed LVH.
LVH regression in patients with hypertension is associated with a reduction in cardiovascular events and can be used as a prognostic marker.
高血压患者的左心室（LV）肥厚（LVH）是心血管疾病死亡率和发病率的重要危险因素。然而，抗高血压治疗后LVH消退的预后意义尚未得到明确研究。
回顾性纳入在高血压诊断时接受超声心动图检查，并在6至18个月的间隔后重复进行超声心动图检查的患者。LVH定义为左心室质量指数（LVMI）>115 g/m²（男性）和>95 g/m²（女性）。LVH消退定义为初始超声心动图显示LVH，随访超声心动图显示几何形态正常或同心性左心室重构。根据LVMI和几何形态的变化分析心血管死亡率、心力衰竭住院（HHF）、冠状动脉血运重建、中风和主动脉事件。
在1872例患者中，44.7%（n = 837）在诊断时患有LVH；其中，30.7%表现出LVH消退。LVMI的降低与血压降低相关，尤其是基线时患有LVH的患者。在随访期间（中位数为50.4个月；四分位间距为24.
