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CARDIAC REMODELING AND DIASTOLIC DYSFUNCTION PRECEDE NON MI-RELATED HEART FAILURE IN HIGH-RISK HYPERTENSIVE PATIENTS: THE LIFE ECHO SUBSTUDY.
A62.E592 JACC March 9, 2010 Volume 55, issue 10A
HYPERTENSION, LIPIDS AND PREVENTION CARDIAC REMODELING AND DIASTOLIC DYSFUNCTION PRECEDE NON MI-RELATED HEART FAILURE IN HIGH-RISK HYPERTENSIVE PATIENTS: THE LIFE ECHO SUBSTUDY. ACC Poster Contributions Georgia World Congress Center, Hall B5 Tuesday, March 16, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Hypertension and heart failure Abstract Category: Hypertension Presentation Number: 1241-110 Authors: Marcello Chinali, Gerard P. Aurigemma, Peter M. Okin, Eva Gerdts, Kristian Wachtell, Sverre E. Kjeldsen, Stevo Julius, Björn Dahlöf, Giovanni de Simone, Richard B. Devereux, University of Massachusetts Medical School, Worcester, MA Background: We evaluated changes in cardiac geometry and function preceding and following incident heart failure (HF) -- in the absence of an intercurrent myocardial infarction (MI) -- in a population of treated hypertensives (HTN). Methods: 926 HTN with ECG- LVH and without history of HF (66±7 years; 45% women), underwent echocardiographic exams annually for 5 years during anti-hypertensive treatment. Data from baseline examination, last examination before HF, and 1st examination after HF event are reported. Results: 23 patients developed HF (2.5%). In five (22%) a preceding MI had occurred, and these patients were excluded from further analyses. Remaining patients who developed HF were older, had higher baseline heart rate and higher rate of pre-existing ischemic heart disease (all p<0.01). As shown in the Table, the last echocardiographic exam performed before the HF event showed a significant reduction in relative wall thickness and a mild increase in LV diameter and a significant increase in mitral E/A ratio paired with shortening of the IVRT. No further changes in echocardiographic parameters where observed after the HF event. No significant changes in ejection fraction were observed either before or after the HF event. Conclusion: In the absence of an intercurent MI, changes in echocardiographic parameters occur before HF develops, characterized by signs of LV dilation and restrictive LV filling pattern, while no change is found in EF. These data may be useful for planning preventive strategies. TABLE. Echocardiographic characteristics of patients developing non-MI related HF during the study Last echo before Baseline P< HF Left Ventricular Mass (g) 260±30 0.05 230±32 Relative Wall Thickness 0.37±0.08 0.05 0.32±0.09 Left Ventricular Diameter (cm) 5.7±0.5 =0.07 5.9±0.6 Ejection Fraction (%) 55±10 NS 53±10 E/A ratio 0.9±0.5 0.05 1.3±0.5 Isovolumic Relaxation Time (msec) 109±10 0.05 90±20
P<
First echo after HF
NS NS NS NS NS NS
220±42 0.31±0.08 5.9±0.3 54±9 1.3±0.6 93±20
HYPERTENSION, LIPIDS AND PREVENTION CARDIAC REMODELING AND DIASTOLIC DYSFUNCTION PRECEDE NON MI-RELATED HEART FAILURE IN HIGH-RISK HYPERTENSIVE PATIENTS: THE LIFE ECHO SUBSTUDY. ACC Poster Contributions Georgia World Congress Center, Hall B5 Tuesday, March 16, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Hypertension and heart failure Abstract Category: Hypertension Presentation Number: 1241-110 Authors: Marcello Chinali, Gerard P. Aurigemma, Peter M. Okin, Eva Gerdts, Kristian Wachtell, Sverre E. Kjeldsen, Stevo Julius, Björn Dahlöf, Giovanni de Simone, Richard B. Devereux, University of Massachusetts Medical School, Worcester, MA Background: We evaluated changes in cardiac geometry and function preceding and following incident heart failure (HF) -- in the absence of an intercurrent myocardial infarction (MI) -- in a population of treated hypertensives (HTN). Methods: 926 HTN with ECG- LVH and without history of HF (66±7 years; 45% women), underwent echocardiographic exams annually for 5 years during anti-hypertensive treatment. Data from baseline examination, last examination before HF, and 1st examination after HF event are reported. Results: 23 patients developed HF (2.5%). In five (22%) a preceding MI had occurred, and these patients were excluded from further analyses. Remaining patients who developed HF were older, had higher baseline heart rate and higher rate of pre-existing ischemic heart disease (all p<0.01). As shown in the Table, the last echocardiographic exam performed before the HF event showed a significant reduction in relative wall thickness and a mild increase in LV diameter and a significant increase in mitral E/A ratio paired with shortening of the IVRT. No further changes in echocardiographic parameters where observed after the HF event. No significant changes in ejection fraction were observed either before or after the HF event. Conclusion: In the absence of an intercurent MI, changes in echocardiographic parameters occur before HF develops, characterized by signs of LV dilation and restrictive LV filling pattern, while no change is found in EF. These data may be useful for planning preventive strategies. TABLE. Echocardiographic characteristics of patients developing non-MI related HF during the study Last echo before Baseline P< HF Left Ventricular Mass (g) 260±30 0.05 230±32 Relative Wall Thickness 0.37±0.08 0.05 0.32±0.09 Left Ventricular Diameter (cm) 5.7±0.5 =0.07 5.9±0.6 Ejection Fraction (%) 55±10 NS 53±10 E/A ratio 0.9±0.5 0.05 1.3±0.5 Isovolumic Relaxation Time (msec) 109±10 0.05 90±20
P<
First echo after HF
NS NS NS NS NS NS
220±42 0.31±0.08 5.9±0.3 54±9 1.3±0.6 93±20