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7.2 Mitral E Wave Deceleration Time to Peak E Velocity Ratio and Cardiovascular Outcome in Hypertensive Patients during Anti-Hypertensive Treatment: the Life Study

  • M. Chinali
  • G. de Simone
  • G.P. Aurigemma
  • R.K. Mishra
  • E. Gerdts
  • K. Wachtell
  • K. Boman
  • B. Dahlöf
  • R.B. Devereux
Contributions from International Congress Imaging Techniques
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7.2 Mitral E Wave Deceleration Time to Peak E Velocity Ratio and Cardiovascular Outcome in Hypertensive Patients during Anti-Hypertensive Treatment: the Life Study

Introduction. Early mitral flow deceleration time (DTE) is a prognostically validated marker of LV chamber stiffness. However, for any given LV stiffness, a higher E peak velocity (pE) is associated with longer DTE, suggesting that the prognostic relevance of DTE might be influenced by variations in cardiac preload (i.e. during anti-hypertensive treatment). It is not known whether normalization of deceleration time for E-velocity (DTE/pE) might be a more stable diastolic index for prediction of incident cardiovascular (CV) events in hypertensive patient s during treatment, as compared to DTE.

Methods. We evaluated 770 hypertensive patients (66±7 years; 42% women) with ECG-LV hypertrophy enrolled in the LIFE echo-substudy. Prognostic value of basal DTE/pE in prediting combined fatal and non-fatal CV events was preliminary evaluated. Echocardiographic exams were per formed annually for 5 years during anti-hypertensive treatment and variation of DTE/pE and of DTE over time were evaluated in relation to incident CV events.

Results. During follow-up, 69 CV events occurred (9% of study population). Mean basal DTE/pE was 3.55±1.55 sec2/cm*10−3. In univariate analysis baseline DTE/pE was positively associated with age (r=0.10; p<0.01), relative wall thickness (r=0.13; p<0.01) and isovolumic relaxation time (r=0.26; p<0.001) and negatively with heart rate (r=-0.20; p<0.001); with no association found for systolic/diastolic blood pressure, LV mass or ejection fraction (all p=NS). Unadjusted Cox regression showed a positive association between basal DTE/pE and CV events [(HR=1.21 (95%CI = 1.07–1.37); p=0.002]. In time-varying Cox model, independently of age, gender, type of anti-hypertensive treatment and intreatment heart rate variation, higher in-treatment DTE/pE was associated with higher rate of CV events [(HR=1.26 (95%CI = 1.04-1.80); p<0.026], with no association found for in treatment DTE (p=NS).

Conclusions. In our population of treated hypertensive patients with ECG-LV hypertrophy, the ratio of in-treatment DTE/pE, but not DTE alone, independently predicted future CV events. In high-risk hypertensive patients, normalization of DTE for pE might be prefer red to DTE in evaluating diastolic function during anti -hypertensive treatment.

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© Adis Data Information BV 2008

Authors and Affiliations

  • M. Chinali
    • 1
  • G. de Simone
    • 1
  • G.P. Aurigemma
    • 2
  • R.K. Mishra
    • 3
  • E. Gerdts
    • 4
  • K. Wachtell
    • 5
  • K. Boman
    • 6
  • B. Dahlöf
    • 7
  • R.B. Devereux
    • 3
  1. 1.Università di Napoli “Federico II”NapoliItaly
  2. 2.University of MassachusettsWorchesterUSA
  3. 3.Weill Cornell Medical CollegeNew YorkUSA
  4. 4.Haukeland University HospitalBergenNorway
  5. 5.Rigshospital etCopenhagenDenmark
  6. 6.Skellefteå LaserattUniversity of UmeåUmeåSweden
  7. 7.Sahlgrenska University Hospital/ÖstraGothenburgSweden

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