Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion. Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV...
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| Format: | Article |
| Language: | English |
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Open Exploration Publishing Inc.
2022-04-01
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| Series: | Exploration of Medicine |
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| Online Access: | https://www.explorationpub.com/Journals/em/Article/100182 |
| _version_ | 1818384634773241856 |
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| author | Marcello Chinali Gerard P. Aurigemma Eva Gerdts Kristian Wachtell Peter M. Okin Anujan Muthiah Sverre E. Kjeldsen Stevo Julius Giovanni de Simone Richard B. Devereux |
| author_facet | Marcello Chinali Gerard P. Aurigemma Eva Gerdts Kristian Wachtell Peter M. Okin Anujan Muthiah Sverre E. Kjeldsen Stevo Julius Giovanni de Simone Richard B. Devereux |
| author_sort | Marcello Chinali |
| collection | DOAJ |
| description | Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion. Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations 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 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) 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 [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001). Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260). |
| first_indexed | 2024-12-14T03:25:23Z |
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| id | doaj.art-ea8b12ec3d1040af891a6ebd87db29f2 |
| institution | Directory Open Access Journal |
| issn | 2692-3106 |
| language | English |
| last_indexed | 2024-12-14T03:25:23Z |
| publishDate | 2022-04-01 |
| publisher | Open Exploration Publishing Inc. |
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| series | Exploration of Medicine |
| spelling | doaj.art-ea8b12ec3d1040af891a6ebd87db29f22022-12-21T23:18:54ZengOpen Exploration Publishing Inc.Exploration of Medicine2692-31062022-04-013216017210.37349/emed.2022.00082Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE StudyMarcello Chinali0Gerard P. Aurigemma1Eva Gerdts2https://orcid.org/0000-0003-4109-2311Kristian Wachtell3https://orcid.org/0000-0001-5861-1478Peter M. Okin4Anujan Muthiah5Sverre E. Kjeldsen6https://orcid.org/0000-0003-2389-0272Stevo Julius7Giovanni de Simone8https://orcid.org/0000-0001-8567-9881Richard B. Devereux9Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USADivision of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USADepartment of Clinical Science, University of Bergen, 5021 Bergen, NorwayGreenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USAGreenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USADepartment of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, NorwayDepartment of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, NorwayDivision of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USAGreenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USAGreenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USAAim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion. Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations 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 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) 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 [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001). Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260).https://www.explorationpub.com/Journals/em/Article/100182blood pressurehypertensionejection fractionleft ventricular hypertrophysystolic dysfunction |
| spellingShingle | Marcello Chinali Gerard P. Aurigemma Eva Gerdts Kristian Wachtell Peter M. Okin Anujan Muthiah Sverre E. Kjeldsen Stevo Julius Giovanni de Simone Richard B. Devereux Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study Exploration of Medicine blood pressure hypertension ejection fraction left ventricular hypertrophy systolic dysfunction |
| title | Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study |
| title_full | Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study |
| title_fullStr | Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study |
| title_full_unstemmed | Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study |
| title_short | Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study |
| title_sort | development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy the life study |
| topic | blood pressure hypertension ejection fraction left ventricular hypertrophy systolic dysfunction |
| url | https://www.explorationpub.com/Journals/em/Article/100182 |
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