Staging Cardiac Damage in Patients With Hypertension

Abstract

Ventricular and extraventricular response to pressure overload may be a common process in aortic stenosis and hypertension. We aimed to evaluate the association of a newly defined staging classification characterizing the extent of cardiac damage, originally developed for aortic stenosis, with long-term outcomes in patients with hypertension. We retrospectively analyzed 1639 patients with hypertension who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a Japanese hospital, after excluding severe and moderate aortic stenosis, aortic regurgitation, mitral stenosis, previous myocardial infarction, or cardiomyopathy. We classified patients according to the presence or absence of cardiac damage as detected on echocardiography as follows: stage 0, no cardiac damage (n=858; 52.3%); stage 1, left ventricular damage (n=358; 21.8%); stage 2, left atrial or mitral valve damage (n=360; 22.0%); or stage 3 and 4, pulmonary vasculature, tricuspid valve, or right ventricular damage (n=63; 3.8%). The primary outcome was a composite of all-cause death and major adverse cardiac events. Cumulative 3-year incidence of the primary outcome was 15.5% in stage 0, 20.7% in stage 1, 31.8% in stage 2, and 60.6% in stage 3. After adjusting for confounders, the stage was incrementally associated with higher risk of the primary outcome (per 1-stage increase: hazard ratio, 1.46 [95% CI, 1.31–1.61]; P <0.001). The staging classification characterizing the extent of cardiac damage, originally developed for aortic stenosis, was associated with long-term outcomes in patients with hypertension in a stepwise manner.

Depressed Cardiac Mechanical Energetic Efficiency: A Contributor to Cardiovascular Risk in Common Metabolic Diseases—From Mechanisms to Clinical Applications

“…In agreement with this concept, the independent association between LVH and HF risk (also corrected for interim myocardial infarction) was described in a similar, yet not identical, group of 1912 SHS participants with preserved EF and without prevalent HF or atherosclerotic CV disease during an average follow-up of 9 years [14]. In addition, the presence of LVH was associated with an increased risk of major adverse CV events (including HF development) and all-cause death in large cohorts of patients with hypertension [30] or symptomatic severe aortic stenosis undergoing transcatheter or surgical valve replacement [31].…”

Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction

“…Thus, change in LV filling pressure may be associated with LA size. Compared with the non-HFrecEF group, the HFrecEF group had a greater decrease in LVMI indicating less pressure loading and a greater decrease in TRPG as well as a lower prevalence of moderate/severe MR indicating less volume loading 24 . Altogether, with improved LVEF, a decrease in LV filling pressure and volume loading may be attributed to LA reverse remodeling.…”

Spectrum of cardiovascular diseases at a referral tertiary care hospital in Somalia, Mogadishu: an echocardiographic study

“…Hypertensive heart disease (HHD) was diagnosed in the presence of signs of heart failure or criteria for concentric/eccentric LV hypertrophy (wall diameters, cavity size, and left ventricular mass index in echocardiography [ 10 ] or diagnostic electrocardiography (ECG) parameters [ 11 ]), left atrial enlargement (anteroposterior diameter, left atrial volume index measured by echocardiography or left atrial dilatation criteria on ECG), and/or presence of at least one of the following parameters; (a) severe left ventricular diastolic dysfunction (E/e’ > 14), (b) left ventricular systolic dysfunction (LVEF < 50%), (c) systolic pulmonary arterial hypertension > 60 mmHg, (d) valvular insufficiency (mitral or tricuspid) considered not to be caused by valvular heart disease (VHD) and/or acute ischemic heart disease, for known or newly diagnosed hypertensive patients (blood pressure > 140/90 mmHg).…”