Key result
Left ventricular longitudinal systolic dysfunction, assessed by AVPD and Sm, is an independent predictor of cardiovascular events in hypertensive patients.
Why the study?
Does left ventricular longitudinal systolic dysfunction predict cardiovascular events in patients with hypertension?
Cohort (n=156)
Does left ventricular longitudinal systolic dysfunction predict cardiovascular events in patients with hypertension?
Left ventricular longitudinal systolic dysfunction, measured by AVPD and Sm, is an independent predictor of cardiovascular events in hypertensive patients, offering higher sensitivity than conventional circumferential indices.
Answers are grounded in this paper and cite their sources.
Longitudinal indices may refine risk stratification in hypertension; leaves open incremental value over standard measures pending validation.
BACKGROUND: To explore the prognostic value of left ventricular (LV) longitudinal systolic dysfunction in patients with hypertension. METHODS: In 156 hypertensive subjects, LV longitudinal systolic function was assessed by echocardiographic measurement of M-mode left atrioventricular plane displacement (AVPD) and Tissue Doppler (TD)-derived mitral annulus peak systolic velocity (Sm). Patients were followed for development of the following cardiovascular events: congestive heart failure requiring hospitalization, new-onset angina, nonfatal myocardial infarction, coronary revascularization procedures, transient ischemic attack, nonfatal stroke, and cardiovascular death. RESULTS: Over a follow-up of 23.3 +/- 5.4 months, 24 patients had 29 events. Both longitudinal systolic indices were predictive of outcome (hazard ratios: AVPD, 0.24, P < 0.001; Sm, 0.22; P < 0.001). AVPD < or = 11.4 mm (75.0% sensitivity and 53.8% specificity) and Sm < or = 8.9 cm/s (79.2% sensitivity and 61.4% specificity) were identified as the best cutoffs for the prediction of cardiovascular events (area under curve: AVPD, 0.66, P < 0.01; Sm, 0.71; P < 0.0001). Compared to conventional indices of circumferential systolic function, AVPD and Sm showed similar overall diagnostic performance, but higher sensitivity and lower specificity. Coexistence of longitudinal and circumferential systolic dysfunction was associated with the worst prognosis (P < 0.0001). Multivariate analysis confirmed an independent association of longitudinal indices with clinical outcome, incremental to circumferential systolic impairment, and other confounding variables. CONCLUSIONS: Longitudinal systolic dysfunction is an independent marker of cardiovascular risk in hypertensive patients. Despite similarity in predictive accuracy, longitudinal indices are more sensitive but less specific than circumferential indices for the prediction of cardiovascular events in these subjects.
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Ballo et al. (2008) conducted a cohort in Hypertension (n=156). Left ventricular longitudinal systolic dysfunction (AVPD and Sm) vs. Normal longitudinal systolic function was evaluated on Cardiovascular events (heart failure hospitalization, angina, MI, revascularization, TIA, stroke, CV death) (HR 0.24, p=<0.001). Left ventricular longitudinal systolic dysfunction, assessed by AVPD and Sm, is an independent predictor of cardiovascular events in hypertensive patients.
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