Abstract 2401: Pulmonary Venous Ratio of Systolic to Diastolic Wave as a Predictor of Cardiovascular Disease in Essential Hypertension
Background: Impaired left ventricular (LV) diastolic function, detected by pulsed Doppler echocardiography, is identified as increased cardiovascular disease (CVD) risk in hypertensives. However, the prognostic significance of pulmonary venous flow (PVF) evaluation remains to be elucidated.
Methods and Results: Doppler transthoracic echocardiograms were analyzed in 705 essential hypertensive subjects (mean age 62 years, 50% female) who were free of prior CVD. In cross sectional analysis at baseline, the peak velocity ratio of pulmonary venous systolic to diastolic wave (s/d) was significantly associated with the transmitral velocity ratio of early diastolic to atrial filling (E/A) (r=−0.58, p<0.001). During follow-up (mean 32 months), 49 subjects (20 female) developed CVD including myocardial infarction, angina pectoris, congestive heart failure, and stroke. Sex-specific median levels were used to separate the higher group from the lower group of s/d (male: <1.51, female: <1.66), and Kaplan-Meier curves showed a significant poorer survival rate in the group with higher s/d level (log-rank χ2=6.86, p<0.01). Similarly, the lower E/A group (male: <0.84, female: <0.82) showed a significant poorer survival rate (log-rank χ2=11.49, p<0.01). We next divided subjects into 4 groups on the basis of the respective sex-specific median levels of s/d in the higher E/A (s/d; male: ≥1.31, female: ≥1.51) and the lower E/A groups (s/d; male: ≥1.77, female: ≥1.81). Kaplan-Meier curves showed a significantly poorer survival rate in the group with higher s/d and lower E/A levels (log-rank χ2=20.10, p<0.01). Multivariate Cox regression analysis showed that the combination of higher s/d and lower E/A was an independent predictor for CVD events, and the risk factor-adjusted hazard ratios were as follows: lower s/d and higher E/A, 1.0; higher s/d and E/A, 1.38; lower s/d and E/A, 1.39; higher s/d and lower E/A, 2.03 (95% CI; 1.26 to 3.58, P<0.01).
Conclusion: Impaired LV diastolic function evaluated by increased s/d and decreased E/A levels at baseline Doppler echocardiography is associated with an increased CVD risk. PVF evaluation by Doppler echocardiography may provide clinically important prognostic information in patients with essential hypertension.