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Influnce of white coat hypertension on cardiac structure and function
176A
POSTERS: Cardiac Structure and Function
AJH–May 2003–VOL. 16, NO. 5, PART 2
(TDE,TDA) velocities at the septal and lateral mitral annulus were measured. LVM was evaluated using M-mode echocardiography.
Systolic BP (mmHg) Diastolic BP (mmHg) Pulse pressure (mmHg) EF (%) LV mass index (g/m2) E/A ratio EDT (ms) IVRT (ms) TDE (cm/s) TDA (cm/s) E/TDE ratio
CAD (nⴝ40)
Controls (nⴝ27)
P-Value
137.1 ⫾ 25.6 79.7 ⫾ 12.7 58.2 ⫾ 19.1 59.8 ⫾ 10.5 146.9 (88.1–338.2) 1.05 (0.55–4.4) 231.3 (123.4–356.4) 148.6 (97.8–245.3) 11.4 ⫾ 3.1 11.5 ⫾ 2.7 7.14 ⫾ 2.1
133.9 ⫾ 13.6 81.3 ⫾ 9.2 52.6 ⫾ 10.7 66.6 ⫾ 6.8 112.6 (83.0–209.2) 1.13 (0.65–3.68) 198.2 (92.1–281.8) 121.9 (75.9–452.6) 13.6 ⫾ 2.5 13.2 ⫾ 2.7 5.64 ⫾ 1.4
0.43 0.56 0.14 0.002 0.001 0.834 0.001 0.017 0.006 0.021 0.004
All PD and TD indices were significantly different between CAD patients and controls except the E/A ratio. PP was significantly correlated with age(r⫽0.34), TDE(r⫽ -0.41) and E/TDE ratio(r⫽0.37)[all p⬍0.05]. LVMi was significantly correlated with systolic(r⫽0.26) and diastolic BP(r⫽0.29), EDT(r⫽0.28), IVRT(r⫽0.35), TDE(r⫽ -0.3) and E/TDE(r⫽0.37)[all p⬍0.05]. Neither PP nor LVMi were related to E/A ratio or LV ejection fraction (EF). PP and LVMi remained significantly related to E/TDE ratio on multiple stepwise regression analysis. In conclusion, increased PP and LVMi are closely associated with impaired LV diastolic filling indices derived from tissue Doppler imaging in this middle-aged population. Key Words: Pulse Pressure, Left Ventricular Mass, Diastolic function by tissue Doppler imaging
P-384 CAROTID AND BRACHIAL INTIMA-MEDIA THICKNESS ARE RELATED TO ECHOCARDIOGRAPHIC LEFT VENTRICULAR MASS INDEX IN PATIENTS WITH CORONARY ARTERY DISEASE WITH AND WITHOUT HYPERTENSION Kaeng Wai Lee, Gregory YH Lip. University Department of Medicine, City Hospital, Birmingham, United Kingdom. Increased left ventricular (LV) mass has been independently associated with increased carotid intima-media thickness (CIMT) but the relationship between LV mass and brachial intima-media thickness (BIMT) is unclear. We studied both indices in 40 patients with coronary artery disease (CAD) (33 male, 56 ⫾ 9yrs) and 27 matched healthy controls (17 male, 53 ⫾ 8yrs). CIMT and BIMT were measured by high-resolution B-mode ultrasound. LV mass was evaluated using the M-mode echocardiography and LV mass index was calculated (LV mass/body surface area).
Systolic BP (mmHg) Diastolic BP (mmHg) LV mass index (g/m2) Carotid IMT (mm) Brachial IMT (mm)
CAD (nⴝ40)
Controls (nⴝ27)
P-Value
137.1 ⫾ 25.6 79.7 ⫾ 12.7 146.9 (88.1–338.2) 1.03 ⫾ 0.25 0.41 ⫾ 0.12
133.9 ⫾ 13.6 81.3 ⫾ 9.2 112.6 (83.0–209.2) 0.75 ⫾ 0.16 0.31 ⫾ 0.09
0.43 0.56 0.001 ⬍0.001 0.001
BP ⫽ blood pressure; IMT ⫽ intima-media thickness; CAD ⫽ coronary artery disease
CAD patients and controls had comparable systolic (SBP) and diastolic blood pressure (DBP). Patients with CAD had significantly higher values of CIMT, BIMT and LV mass index compared to controls. LV mass index was positively correlated with CIMT (r⫽0.4), BIMT (r⫽0.3), SBP (r⫽0.26) and DBP (r⫽0.3) [all p⬍0.05]. Age was significantly correlated with CIMT (r⫽0.4) and SBP (r⫽0.3). CIMT and BIMT were significantly related to each other (r⫽0.3). Subjects with left ventricular hypertrophy (n⫽33) (LV mass index ⬎134g/m2 in men, ⬎110g/m2in women) had a greater CIMT (1.0⫾0.3 v 0.8⫾0.2 mm) and BIMT (0.4⫾0.1 v 0.3⫾0.1 mm) [both p⬍0.05]. On multiple stepwise regression analysis, increased CIMT and BIMT remained significantly and indepen-
dently related to LV mass index even after adjusting for age, SBP and DBP. In conclusion, intima-media thickening at both the carotid and brachial positions is independently associated with echocardiographic LV mass index in patients with CAD with or without a history of hypertension. Key Words: Left ventricular mass, intima-media thickness, Brachial artery
P-385 INFLUNCE OF WHITE COAT HYPERTENSION ON CARDIAC STRUCTURE AND FUNCTION Jing Li, Qi Hua. Department of Cardiology,Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. To know the incidence of white coat hypertension in the population firstly diagnosed as hypertension and assess the structure and function of heart in patients with white coat hypertension(WCH). 234 patients with essential hypertension were divided into WCH (65 patients) and sustained hypertension(SH) (169 patients) by clinical and 24-hour ambulatory blood pressure. 18 age matched healthy subjects were control. The structure and function of the heart was measured by echocardiography. The incidence of WCH was 28%. The incidence was higher in female or in isolated systolic hypertension. The LAD, PWTd and LVMI in WCH patients were higher than those in normal group but less than those in SH. The diastolic function was decreased in WCH group compared with normal groups. There were changes of left ventricular diastolic function and remodeling of left ventricle in WCH patients. Key Words: White coat hypertension, Left ventricular function
P-386 LEFT VENTRICULAR HYPERTROPHY REGRESSION WITH ANGIOTENSIN CONVERTING ENZYME INHIBITOR ANTIHYPERTENSIVE TREATMENT DEPENDS ON THE DIPPING STATUS AND LEFT VENTRICULAR GEOMETRY PATTERN G. P. Vyssoulis, A. G. Marinakis, C. Stavrotheodoros, E. A. Karpanou, D. V. Cokkinos, P. K. Toutouzas. Cardiology Dept, Athens University, Athens, Greece. Left ventricular hypertrophy (LVH) is a major cardiovascular risk factor in arterial hypertension and thus a significant therapeutic goal. Impaired sympathetic activity and left ventricular (LV) geometry pattern are independent informative parameters of total risk. To assess the interaction of these indices, we examined left ventricular mass index (LVMI) regression achieved after a 6 month period of angiotensin converting enzyme inhibition (ACEI) monotherapy. The study comprised 1111 consecutive patients with uncomplicated essential hypertension . LVMI and LV geometry pattern were derived from echocardiography and the dipping pattern was determined by 24hour ambulatory blood pressure monitoring. When coevaluating the dipping pattern and LV geometry pattern, 8 groups of patients were formed: 147 dippers with normal geometry, 180 dippers with concentric remodeling, 114 dippers with eccentric hypertrophy, 173 dippers with concentric hypertrophy, 87 non dippers with normal geometry, 92 non dippers with concentric remodeling, 113 non dippers with eccentric hypertrophy and 214 non dippers with concentric hypertrophy. LVMI regression was achieved (-13.1%) with no differences among the specific agents used (p⫽NS). It was higher in non dippers (-14.1 vs –12.3% , p⬍0.0001) and patients with baseline LVH (14.6 vs 11.3% , p⬍0.0001). When the 8 groups were assessed seperately, LVMI regression differentiated (F⫽36, p⬍0.0001), with best results in non dippers with concentric hypertrophy (-15.9%) and relatively poorer in dippers with normal LV geometry pattern. The corelations of LVMI decrease to LVH , LV geometry pattern and dipping pattern were significant
POSTERS: Cardiac Structure and Function
AJH–May 2003–VOL. 16, NO. 5, PART 2
(TDE,TDA) velocities at the septal and lateral mitral annulus were measured. LVM was evaluated using M-mode echocardiography.
Systolic BP (mmHg) Diastolic BP (mmHg) Pulse pressure (mmHg) EF (%) LV mass index (g/m2) E/A ratio EDT (ms) IVRT (ms) TDE (cm/s) TDA (cm/s) E/TDE ratio
CAD (nⴝ40)
Controls (nⴝ27)
P-Value
137.1 ⫾ 25.6 79.7 ⫾ 12.7 58.2 ⫾ 19.1 59.8 ⫾ 10.5 146.9 (88.1–338.2) 1.05 (0.55–4.4) 231.3 (123.4–356.4) 148.6 (97.8–245.3) 11.4 ⫾ 3.1 11.5 ⫾ 2.7 7.14 ⫾ 2.1
133.9 ⫾ 13.6 81.3 ⫾ 9.2 52.6 ⫾ 10.7 66.6 ⫾ 6.8 112.6 (83.0–209.2) 1.13 (0.65–3.68) 198.2 (92.1–281.8) 121.9 (75.9–452.6) 13.6 ⫾ 2.5 13.2 ⫾ 2.7 5.64 ⫾ 1.4
0.43 0.56 0.14 0.002 0.001 0.834 0.001 0.017 0.006 0.021 0.004
All PD and TD indices were significantly different between CAD patients and controls except the E/A ratio. PP was significantly correlated with age(r⫽0.34), TDE(r⫽ -0.41) and E/TDE ratio(r⫽0.37)[all p⬍0.05]. LVMi was significantly correlated with systolic(r⫽0.26) and diastolic BP(r⫽0.29), EDT(r⫽0.28), IVRT(r⫽0.35), TDE(r⫽ -0.3) and E/TDE(r⫽0.37)[all p⬍0.05]. Neither PP nor LVMi were related to E/A ratio or LV ejection fraction (EF). PP and LVMi remained significantly related to E/TDE ratio on multiple stepwise regression analysis. In conclusion, increased PP and LVMi are closely associated with impaired LV diastolic filling indices derived from tissue Doppler imaging in this middle-aged population. Key Words: Pulse Pressure, Left Ventricular Mass, Diastolic function by tissue Doppler imaging
P-384 CAROTID AND BRACHIAL INTIMA-MEDIA THICKNESS ARE RELATED TO ECHOCARDIOGRAPHIC LEFT VENTRICULAR MASS INDEX IN PATIENTS WITH CORONARY ARTERY DISEASE WITH AND WITHOUT HYPERTENSION Kaeng Wai Lee, Gregory YH Lip. University Department of Medicine, City Hospital, Birmingham, United Kingdom. Increased left ventricular (LV) mass has been independently associated with increased carotid intima-media thickness (CIMT) but the relationship between LV mass and brachial intima-media thickness (BIMT) is unclear. We studied both indices in 40 patients with coronary artery disease (CAD) (33 male, 56 ⫾ 9yrs) and 27 matched healthy controls (17 male, 53 ⫾ 8yrs). CIMT and BIMT were measured by high-resolution B-mode ultrasound. LV mass was evaluated using the M-mode echocardiography and LV mass index was calculated (LV mass/body surface area).
Systolic BP (mmHg) Diastolic BP (mmHg) LV mass index (g/m2) Carotid IMT (mm) Brachial IMT (mm)
CAD (nⴝ40)
Controls (nⴝ27)
P-Value
137.1 ⫾ 25.6 79.7 ⫾ 12.7 146.9 (88.1–338.2) 1.03 ⫾ 0.25 0.41 ⫾ 0.12
133.9 ⫾ 13.6 81.3 ⫾ 9.2 112.6 (83.0–209.2) 0.75 ⫾ 0.16 0.31 ⫾ 0.09
0.43 0.56 0.001 ⬍0.001 0.001
BP ⫽ blood pressure; IMT ⫽ intima-media thickness; CAD ⫽ coronary artery disease
CAD patients and controls had comparable systolic (SBP) and diastolic blood pressure (DBP). Patients with CAD had significantly higher values of CIMT, BIMT and LV mass index compared to controls. LV mass index was positively correlated with CIMT (r⫽0.4), BIMT (r⫽0.3), SBP (r⫽0.26) and DBP (r⫽0.3) [all p⬍0.05]. Age was significantly correlated with CIMT (r⫽0.4) and SBP (r⫽0.3). CIMT and BIMT were significantly related to each other (r⫽0.3). Subjects with left ventricular hypertrophy (n⫽33) (LV mass index ⬎134g/m2 in men, ⬎110g/m2in women) had a greater CIMT (1.0⫾0.3 v 0.8⫾0.2 mm) and BIMT (0.4⫾0.1 v 0.3⫾0.1 mm) [both p⬍0.05]. On multiple stepwise regression analysis, increased CIMT and BIMT remained significantly and indepen-
dently related to LV mass index even after adjusting for age, SBP and DBP. In conclusion, intima-media thickening at both the carotid and brachial positions is independently associated with echocardiographic LV mass index in patients with CAD with or without a history of hypertension. Key Words: Left ventricular mass, intima-media thickness, Brachial artery
P-385 INFLUNCE OF WHITE COAT HYPERTENSION ON CARDIAC STRUCTURE AND FUNCTION Jing Li, Qi Hua. Department of Cardiology,Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. To know the incidence of white coat hypertension in the population firstly diagnosed as hypertension and assess the structure and function of heart in patients with white coat hypertension(WCH). 234 patients with essential hypertension were divided into WCH (65 patients) and sustained hypertension(SH) (169 patients) by clinical and 24-hour ambulatory blood pressure. 18 age matched healthy subjects were control. The structure and function of the heart was measured by echocardiography. The incidence of WCH was 28%. The incidence was higher in female or in isolated systolic hypertension. The LAD, PWTd and LVMI in WCH patients were higher than those in normal group but less than those in SH. The diastolic function was decreased in WCH group compared with normal groups. There were changes of left ventricular diastolic function and remodeling of left ventricle in WCH patients. Key Words: White coat hypertension, Left ventricular function
P-386 LEFT VENTRICULAR HYPERTROPHY REGRESSION WITH ANGIOTENSIN CONVERTING ENZYME INHIBITOR ANTIHYPERTENSIVE TREATMENT DEPENDS ON THE DIPPING STATUS AND LEFT VENTRICULAR GEOMETRY PATTERN G. P. Vyssoulis, A. G. Marinakis, C. Stavrotheodoros, E. A. Karpanou, D. V. Cokkinos, P. K. Toutouzas. Cardiology Dept, Athens University, Athens, Greece. Left ventricular hypertrophy (LVH) is a major cardiovascular risk factor in arterial hypertension and thus a significant therapeutic goal. Impaired sympathetic activity and left ventricular (LV) geometry pattern are independent informative parameters of total risk. To assess the interaction of these indices, we examined left ventricular mass index (LVMI) regression achieved after a 6 month period of angiotensin converting enzyme inhibition (ACEI) monotherapy. The study comprised 1111 consecutive patients with uncomplicated essential hypertension . LVMI and LV geometry pattern were derived from echocardiography and the dipping pattern was determined by 24hour ambulatory blood pressure monitoring. When coevaluating the dipping pattern and LV geometry pattern, 8 groups of patients were formed: 147 dippers with normal geometry, 180 dippers with concentric remodeling, 114 dippers with eccentric hypertrophy, 173 dippers with concentric hypertrophy, 87 non dippers with normal geometry, 92 non dippers with concentric remodeling, 113 non dippers with eccentric hypertrophy and 214 non dippers with concentric hypertrophy. LVMI regression was achieved (-13.1%) with no differences among the specific agents used (p⫽NS). It was higher in non dippers (-14.1 vs –12.3% , p⬍0.0001) and patients with baseline LVH (14.6 vs 11.3% , p⬍0.0001). When the 8 groups were assessed seperately, LVMI regression differentiated (F⫽36, p⬍0.0001), with best results in non dippers with concentric hypertrophy (-15.9%) and relatively poorer in dippers with normal LV geometry pattern. The corelations of LVMI decrease to LVH , LV geometry pattern and dipping pattern were significant