Abstract 13660: Left Ventricular Mass Versus Pulse Wave Velocity as Predictors of Coronary Artery Disease in Patients With Essential Hypertension: Data From a Greek 6-Year-Follow-Up Study
Introduction: Although arterial stiffening is related to atherosclerosis progression, its prognostic role in hypertension is not fully elucidated, while augmented left ventricular mass index (LVMI) is linked to adverse outcome.
Hypothesis: The aim of the present study was to compare the predictive role of arterial stiffness and LVMI for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients.
Methods: We followed up 1128 essential hypertensives (mean age 56.1 years, 587 males, office blood pressure (BP)=144/91 mmHg) free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and at baseline underwent complete echocardiographic study. Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method (Complior SP) and the distribution of PWV was split by the median (8.1 m/sec) and accordingly subjects were classified into those with high (n=566) and low values (n=562). Moreover, LV hypertrophy (LVH) was defined as LVMI ≥125 g/m2 in males and LVMI ≥110 g/m2 in females, while CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure.
Results: The incidence of CAD over the follow-up period was 2.83%. Hypertensives who developed CAD (n=32) compared to those without CAD at follow-up (n=1096) had at baseline higher waist circumference (101.8±11.1 vs 97.2±11.9 cm, p=0.033), LVMI (123.7±22.9 vs 107±24.2 g/m2, p=0.014), prevalence of LVH (46% vs 25%, p=0.027) and prevalence of high PWV levels (69% vs 48%, p=0.019). By univariate Cox regression analysis it was revealed that high baseline PWV levels predicted CAD (hazard ratio=2.657, p=0.008). However, in multivariate Cox regression model, waist circumference (hazard ratio=1.016, p=0.04) and LVMI (hazard ratio=1.023, p=0.018) but not high baseline PWV turned out to be independent predictors of CAD.
Conclusions: In essential hypertensive patients LVMI predicts future development of CAD, whereas high baseline PWV exhibits no independent prognostic value. These findings support that LVMI constitutes a superior prognosticator of events than PWV in hypertension.
- © 2013 by American Heart Association, Inc.