Abstract 5862: Development of Systolic Dysfunction Not Related to Myocardial Infarction in Treated Hypertensive Patients With Left Ventricular Hypertrophy: The LIFE Echo Substudy
Background: While it is commonly thought that left ventricular (LV) systolic function deteriorates insidiously in hypertensive patients (burnt-out hypertensive heart), few prospective data are available to support this notion. Accordingly, the aim of this study was to identify echocardiographic predictors of reduced EF in a population of hypertensive patients.
Methods: We evaluated 703 hypertensive patients (66±7 years; 45% women) enrolled in the LIFE echo-substudy. Only patients free of prevalent cardiovascular disease and with baseline ejection fraction (EF)<55% were included. Echocardiographic exams were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF<50%.
Results: During a mean follow up of 5±1 years, 37 patients developed reduced EF without an intercurrent myocardial infarction. Patients who developed reduced EF were more often men (p<0.05). In analysis of covariance, patients who developed reduced EF had greater baseline LV diameter and LV mass, lower mean EF (all p<0.05), and similar diastolic function indices as compared to patients who did not develop reduced EF. As shown in the Table⇓, at last available exam before EF reduction, patients with reduced EF showed a significant increase in left atrial size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all p<0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter (HR=5.2; 95%CI:2.6 –10.4; p<0.001) and higher in-treatment mitral E/A ratio (HR=2.4; 95%CI:1.6 –3.6; p<0.001).
Conclusions: In treated hypertensive patients, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure. Higher in-treatment LV diameter and mitral E/A ratio are the strongest echocardiographic predictors of reduced EF.