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Clinical significance of hypertension in patients with atrial fibrillation
S84
Abstracts
From January 2008 to December 2008, 133 consecutive patients hospitalized who are satisfying the following conditions: (i) signs or symptoms of heart failure; (ii) preserved systolic LV function; (iii) evidence of diastolic LV dysfunction, and 78 heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF<50%) were included in this study. All patients evaluated heart function by NYHA class. Plasma concentrations of the NT-proBNP were measured by ECLIA on admission. LVEF was measured by Simpson's equation with Doppler echocardiography. All patients discharged were followed up a median of 240 days. The recurrent cardiac event was cardiac death or decompensated HF readmission. Results: (1) Compared with HF and reduced LVEF group, HFPEF group had a significantly higher age and percentage of hypertension, lower NYHA class degree, lower left ventricular end-diastolic dimension and median plasma NT-proBNP level (2,016.0 vs. 4,787.0 Pg/ ml), all P<0.01, higher percentage of CAD and diabetes, all P<0.05, but recurrent cardiovascular events were not significantly different in the two groups (26/78 vs. 30/133, P>0.05). (2) On a Cox proportional hazards analysis, LogNT-proBNP was found to be the strongest independent predictor of cardiac events. OR was 4.865 (95%CI: 1.607–14.726, P=0.005). (3) On a Kaplan–Meier survival curve, NT-proBNP>2,016 Pg/ml on admission was associated with increased cardiac events (HR – 3.688, 95%CI: 1.502–9.056, P=0.003). Conclusions: Plasma NT-proBNP level on admission is an important predictor of readmission and death within 240 days after hospital discharge in patients with HFPEF. NTproBNP>2,016 Pg/ml predicted an unfavourable prognosis. doi:10.1016/j.ijcard.2009.09.281 HF000544 Clinical significance of hypertension in patients with atrial fibrillation SE-JOONG RIMa,e, SANG-HAK LEEa, WOOK-JIN CHUNGb, YOUNG-SUP BYUNc, SUNG-KEE RYUd, WOOK-BUM PYUNa a Yonsei University, Republic of Korea b Gachon University, Republic of Korea c Inje University, Republic of Korea d Eulji University, Republic of Korea e Ewha University, Republic of Korea Background: We have previously shown that the severity of diastolic dysfunction is related to ischemic stroke in patients with atrial fibrillation (AF) and preserved left ventricular (LV) ejection fraction (EF). Hypertension increases the morbidity and mortality in a patient with AF. We hypothesized that the presence of hypertension and resultant cardiac structural change may be related to the severity of diastolic dysfunction in patients with atrial fibrillation. Methods: Two hundred ninety four patients with persistent non-valvular AF who had preserved LVEF were included from 6 centers. Clinical data were obtained and standard transthoracic echocardiography was performed. Patients without a history of hypertension (n=125) were compared with patients with hypertension (n=169). Results: Older age, female sex, diabetes mellitus, previous stroke and higher plasma brain natriuretic peptide level were significantly related to hypertension. Among echocardiographic parameters, diastolic mitral annular velocity (E′) (8.3± 2.2 vs 7.7±2.1, p<0.05), E/E′ ratio (11.0±4.5 vs 12.1±4.4, p<0.05), deceleration time of early mitral inflow velocity (E) (175±44 vs 163±39, p<0.05) and left atrial volume index (LAVI) (40.5±18.9 vs 46.4±20.2, p<0.05) were significantly different between two groups, although E and LVEF were not different. LV mass index was independently related to hypertension in multivariate analysis of echocardiographic structural and functional parameters. In multivariate analysis, increased LV mass index was the significant independent predictor of increased LA size in patients with AF. Conclusion: In patients with AF, echocardiographic LV diastolic parameters were further impaired when hypertension was coexistent. In patients with hypertension and AF, increased LV mass index may precede abnormalities of other diastolic parameters. In patients with AF and
hypertension, aggressive treatment of LV hypertrophy may be beneficial in reducing its complications such as stroke. doi:10.1016/j.ijcard.2009.09.282 HF000554 How to diagnose heart failure with normal ejection fraction? From a Chinese study X.X. SHUAIa, Y.X. LUa, G.H. SUa, Y.Y. CHENb a Department of Cardiology, Wuhan Union Hospital, Huazhong University of Science and Technology, China b Department of Echocardiology, Wuhan Union Hospital, Huazhong University of Science and Technology, China Objectives: About the diagnostic criteria for heart failure with normal ejection fraction (HFNEF), there are differences in the guidelines from ESC and ACC/AHA, and other scholars. The aim of our study is to discuss the present main diagnostic criteria, and to find the most useful parameters for diagnosis. Design and methods: 145 consecutive subjects were studied by 2D echocardiography at rest with measurement of early mitral valve inflow velocity (E) and Tissue Doppler Imaging of early diastolic velocity of the septal mitral annulus (e′). Left atrial volume (LAV) was calculated by Biplane Simpson's method. Plasma concentrations of NT-proBNP were measured by electrochemiluminescence immunoassay. Results: In 35 healthy controls, 56 patients with asymptomatic left ventricular diastolic dysfunction (ALVD), and 54 with HFNEF in NYHA classes II and III, values of NT-proBNP were 31 ± 19, 63 ± 48, 239 ± 189, and 717 ± 719 pg/ml (P < 0.001), and LAVI 23.8 ± 5.7, 29.1 ± 7.1, 34.4 ±9.0, and 41.8 ± 14.3 ml/m2 (P < 0.001), left ventricular muscle weight index (LVMI) 75 ± 14, 89 ± 17, 102 ± 28, and 113 ± 36 g/m2 (P < 0.002), E/e′ 9.4 ± 1.7, 11.3 ± 3.2, 13.1 ± 3.5, and 22.3 ± 12.7 (P < 0.001) respectively. NT-proBNP (r = 0.761), E/e′ (r = 0.611), LAVI (r = 0.600), LVMI (r = 0.53), and e′ (r = −0.67) (P < 0.0001) were significantly correlated to NYHA classification. According to the diagnostic criteria from Lester S.J. (USA) and ESC, sensitivities of LAVI > 28, >40 ml/m2, E/e′ > 15, LVMI > 122 (female) or >149 (male), and NT-proBNP > 220 pg/ ml to diagnose HFNEF were 78, 37, 53, 25, and 56%, while specificities were 57, 96, 93, 99, and 82% respectively. Conclusions: The diagnosis of HFNEF is primarily based on signs and symptoms of heart failure and normal LVEF. Echocardiographic indexes are of very important value, LAVI > 28 ml/m2 has the highest sensitivity while E/e′ > 15 and LVMI > 122 (female) or >149 (male) have the highest specificity. doi:10.1016/j.ijcard.2009.09.283 HF000574 Pre-hypertension and the risk of heart failure in Chinese older adults XUEJUAN JIN, JINGMIN ZHOU, JUN ZHOU, AIJUN SUN, JUNBO GE Zhongshan Hospital, Fudan University, China Objective: To investigate the prevalence of both pre-hypertension and hypertension, and risk factors associated with the clinically diagnosed chronic congestive heart failure (CHF). Design and methods: A community-based cross-sectional screening of 5,985 individuals aged 40 to 95 years old was conducted during the period from September to December 2008 at one community in rural Shanghai, China. By applying the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Hypertension criteria, pre-hypertension was defined as systolic blood pressure (SBP) ranging from 120 to 139 mm Hg or diastolic blood pressure (DBP) 80 to 89 mm Hg based on an average of
Abstracts
From January 2008 to December 2008, 133 consecutive patients hospitalized who are satisfying the following conditions: (i) signs or symptoms of heart failure; (ii) preserved systolic LV function; (iii) evidence of diastolic LV dysfunction, and 78 heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF<50%) were included in this study. All patients evaluated heart function by NYHA class. Plasma concentrations of the NT-proBNP were measured by ECLIA on admission. LVEF was measured by Simpson's equation with Doppler echocardiography. All patients discharged were followed up a median of 240 days. The recurrent cardiac event was cardiac death or decompensated HF readmission. Results: (1) Compared with HF and reduced LVEF group, HFPEF group had a significantly higher age and percentage of hypertension, lower NYHA class degree, lower left ventricular end-diastolic dimension and median plasma NT-proBNP level (2,016.0 vs. 4,787.0 Pg/ ml), all P<0.01, higher percentage of CAD and diabetes, all P<0.05, but recurrent cardiovascular events were not significantly different in the two groups (26/78 vs. 30/133, P>0.05). (2) On a Cox proportional hazards analysis, LogNT-proBNP was found to be the strongest independent predictor of cardiac events. OR was 4.865 (95%CI: 1.607–14.726, P=0.005). (3) On a Kaplan–Meier survival curve, NT-proBNP>2,016 Pg/ml on admission was associated with increased cardiac events (HR – 3.688, 95%CI: 1.502–9.056, P=0.003). Conclusions: Plasma NT-proBNP level on admission is an important predictor of readmission and death within 240 days after hospital discharge in patients with HFPEF. NTproBNP>2,016 Pg/ml predicted an unfavourable prognosis. doi:10.1016/j.ijcard.2009.09.281 HF000544 Clinical significance of hypertension in patients with atrial fibrillation SE-JOONG RIMa,e, SANG-HAK LEEa, WOOK-JIN CHUNGb, YOUNG-SUP BYUNc, SUNG-KEE RYUd, WOOK-BUM PYUNa a Yonsei University, Republic of Korea b Gachon University, Republic of Korea c Inje University, Republic of Korea d Eulji University, Republic of Korea e Ewha University, Republic of Korea Background: We have previously shown that the severity of diastolic dysfunction is related to ischemic stroke in patients with atrial fibrillation (AF) and preserved left ventricular (LV) ejection fraction (EF). Hypertension increases the morbidity and mortality in a patient with AF. We hypothesized that the presence of hypertension and resultant cardiac structural change may be related to the severity of diastolic dysfunction in patients with atrial fibrillation. Methods: Two hundred ninety four patients with persistent non-valvular AF who had preserved LVEF were included from 6 centers. Clinical data were obtained and standard transthoracic echocardiography was performed. Patients without a history of hypertension (n=125) were compared with patients with hypertension (n=169). Results: Older age, female sex, diabetes mellitus, previous stroke and higher plasma brain natriuretic peptide level were significantly related to hypertension. Among echocardiographic parameters, diastolic mitral annular velocity (E′) (8.3± 2.2 vs 7.7±2.1, p<0.05), E/E′ ratio (11.0±4.5 vs 12.1±4.4, p<0.05), deceleration time of early mitral inflow velocity (E) (175±44 vs 163±39, p<0.05) and left atrial volume index (LAVI) (40.5±18.9 vs 46.4±20.2, p<0.05) were significantly different between two groups, although E and LVEF were not different. LV mass index was independently related to hypertension in multivariate analysis of echocardiographic structural and functional parameters. In multivariate analysis, increased LV mass index was the significant independent predictor of increased LA size in patients with AF. Conclusion: In patients with AF, echocardiographic LV diastolic parameters were further impaired when hypertension was coexistent. In patients with hypertension and AF, increased LV mass index may precede abnormalities of other diastolic parameters. In patients with AF and
hypertension, aggressive treatment of LV hypertrophy may be beneficial in reducing its complications such as stroke. doi:10.1016/j.ijcard.2009.09.282 HF000554 How to diagnose heart failure with normal ejection fraction? From a Chinese study X.X. SHUAIa, Y.X. LUa, G.H. SUa, Y.Y. CHENb a Department of Cardiology, Wuhan Union Hospital, Huazhong University of Science and Technology, China b Department of Echocardiology, Wuhan Union Hospital, Huazhong University of Science and Technology, China Objectives: About the diagnostic criteria for heart failure with normal ejection fraction (HFNEF), there are differences in the guidelines from ESC and ACC/AHA, and other scholars. The aim of our study is to discuss the present main diagnostic criteria, and to find the most useful parameters for diagnosis. Design and methods: 145 consecutive subjects were studied by 2D echocardiography at rest with measurement of early mitral valve inflow velocity (E) and Tissue Doppler Imaging of early diastolic velocity of the septal mitral annulus (e′). Left atrial volume (LAV) was calculated by Biplane Simpson's method. Plasma concentrations of NT-proBNP were measured by electrochemiluminescence immunoassay. Results: In 35 healthy controls, 56 patients with asymptomatic left ventricular diastolic dysfunction (ALVD), and 54 with HFNEF in NYHA classes II and III, values of NT-proBNP were 31 ± 19, 63 ± 48, 239 ± 189, and 717 ± 719 pg/ml (P < 0.001), and LAVI 23.8 ± 5.7, 29.1 ± 7.1, 34.4 ±9.0, and 41.8 ± 14.3 ml/m2 (P < 0.001), left ventricular muscle weight index (LVMI) 75 ± 14, 89 ± 17, 102 ± 28, and 113 ± 36 g/m2 (P < 0.002), E/e′ 9.4 ± 1.7, 11.3 ± 3.2, 13.1 ± 3.5, and 22.3 ± 12.7 (P < 0.001) respectively. NT-proBNP (r = 0.761), E/e′ (r = 0.611), LAVI (r = 0.600), LVMI (r = 0.53), and e′ (r = −0.67) (P < 0.0001) were significantly correlated to NYHA classification. According to the diagnostic criteria from Lester S.J. (USA) and ESC, sensitivities of LAVI > 28, >40 ml/m2, E/e′ > 15, LVMI > 122 (female) or >149 (male), and NT-proBNP > 220 pg/ ml to diagnose HFNEF were 78, 37, 53, 25, and 56%, while specificities were 57, 96, 93, 99, and 82% respectively. Conclusions: The diagnosis of HFNEF is primarily based on signs and symptoms of heart failure and normal LVEF. Echocardiographic indexes are of very important value, LAVI > 28 ml/m2 has the highest sensitivity while E/e′ > 15 and LVMI > 122 (female) or >149 (male) have the highest specificity. doi:10.1016/j.ijcard.2009.09.283 HF000574 Pre-hypertension and the risk of heart failure in Chinese older adults XUEJUAN JIN, JINGMIN ZHOU, JUN ZHOU, AIJUN SUN, JUNBO GE Zhongshan Hospital, Fudan University, China Objective: To investigate the prevalence of both pre-hypertension and hypertension, and risk factors associated with the clinically diagnosed chronic congestive heart failure (CHF). Design and methods: A community-based cross-sectional screening of 5,985 individuals aged 40 to 95 years old was conducted during the period from September to December 2008 at one community in rural Shanghai, China. By applying the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Hypertension criteria, pre-hypertension was defined as systolic blood pressure (SBP) ranging from 120 to 139 mm Hg or diastolic blood pressure (DBP) 80 to 89 mm Hg based on an average of