e490 Journal of Hypertension Vol 29, e-Supplement A, June 2011
Results: Although baseline values of E/E’ in H and C group were in normal
limits (< 8), compared to controls H patients had higher E/E’ ratio at rest
(5.5 ± 0.77 vs. 4,25 ± 0.83, p < 0.001). In C group E/E’ ratio did not increase
during exercise. Out of 55 hypertensive pts 38(69%) had no increase in E/E’
during exercise, while exercise E/E’ rised in 17(31%) pts (from 6.2 ± 0.48 to
10.1 ± 1.06, p < 0.0001; difference 63%). The percentage of dyspnea as a
primary reason for stopping exercise was similar in hypertensive pts with and
those without exercise increased E/E’. However, exercise duration was sig-
nificantly shorter in hypertensive pts with than in pts without raised exercise
E/E’ (p < 0.025).
Conclusion: In hypertensive patients with preserved global LV diastolic
function at rest, increased E/E’ during diastolic stress echocardiography may
uncover those with subclinical diastolic dysfunction.
PP.36.204 CAN THE SILENT MYOCARDIAL ISCHEMIA BE
DETECTED IN ARTERIAL HYPERTENSIVE PATIENTS
WITH LEFT VENTRICULAR REMODELING?
S. Gurgenyan, S. Vatinyan, K. Nikoghosyan. Institute f Cardiology, Yerevan-
Armenia
Objective: Left ventricular (LV) hypertrophy often accompany with myocardial
ischemia (MI). The aims of present study is to demonstrate that the symptoms of
MI subsist in arterial hypertensive (AH) patients (pts) with LVH without clini-
cally coronary arterial disease (CAD).
Design and Method: We studied 43 pts with moderate AH (24 male and
19 female, mean age 52.1 ± 9.1 years). In all pts were performed 24-h ECG
Holter monitoring, in 40 - bicycle exercise ECG (begun with 25 W, increasing
by 25 W every 4 min), in 39 were evaluated the changes of wall motion score
index (WMCI) at rest and at peak by the dobutamine stress-echocardiography
(SE), in 26 - the myocardial scintigraphy by use of 99mTc– pyrophosphate and in
17 - 103TL and in 19 – coronary angiography.
Results: Fifty (34.8%) pts had an episode of SI in 24-h ECG Holter monitor-
ing. Twenty (46.5.%) pts had > 0.1 mV of ST-segment depression and negative
T wave in V5 and V6 in exercise ECG relative to the rest. The WMCI was
observed in 9 (20.9%) pts at rest and in 27 (62.7%) – at peak (was deter-
mined by new wall motion abnormalities). In 22 (51.1%) pts the myocardial
scintigraphy reveal the myocardial ischemic injuries. In 19 AH pts with LV
remodeling and SI parameters with clinic diagnosis of the attendant CAD were
performed coronary angiography. In 15 pts were excluded CAD events and
only in 4 of them was confirmed the CAD diagnosis.
Conclusions: In the absence of CAD the MI events in AH pts are presented
as a result of LV remodeling and as possible is related with anomalies of
coronary microcirculation. Non-invasive diagnostic tests for detect of CAD
are not always adequate in AH pts. If diagnostic doubt preserves after the
loaded test or a myocardial scintigraphy in AH pts coronary angiography can
be necessary.
PP.36.205 PROGNOSTIC VALUE OF LEFT VENTRICULAR
HYPERTROPHY AND BLOOD PRESSURE
VARIABILITY
S. Cinza Sanjurgo1, A. Hermida Ameijeiras2, Je López Paz2, M. Pena Seijo2,
G. Calvo González2, Ml Romero Miguez2, V. Martinez Durán2, A. Pascual
Montes2, J.M. Paz Fernández2, C. Calvo Gómez2. 1Malpica Health Center,
Malpica-Spain, 2University Hospital Complex of Santiago, Santiago De
Compostela-Spain
Introduction and Objectives: Left Ventricular Hypertrophy (LVH) is the earli-
est manifestation of cardiac effect in hypertensive patients and is an independent
risk factor for cardiovascular complications. The objective of this study was to
determine the prognosis cardiovascular (CV) of hypertensive patients with LVH,
based on the variability of blood pressure (BP) assessed by ABPM.
Methods: Cohort study in a sample of 432 hypertensive patients (218 women,
55.5 years) and without cardiovascular disease (CV) prior. In all cases, clinical
assessment and biological, ABPM-24h and echocardiography (Pen conven-
tion, with calculation of left ventricular mass index-LVMI, normalized for
body surface area and height-SC-AL). The monitoring of patients was per-
formed by review of medical history, recording the type of event (peripheral
arterial disease, PAD, Coronary Disease-CD, heart failure-HF or stroke) and
recording the event date.
Results: Completed follow-up 405 patients (218 women, mean age 55.5
years). Patients with LVH have more events, IT = 5.99 compared to 3.06 for
those without LVH (IRR: 1.96 [1.42 to 2.72]). The Kaplan-Meier curve shows
less free time events in the LVH group. Concentric LVH has a worse progno-
sis: RTI 3.99, 2.69 to 5.91). LVH with dipper profile increased events (IRR:
7.19 [3.29 to 15.74]); and non-dipper and riser profiles with LVH (12.18 [5.77
to 25.72] and 20,98 [9.81 to 44.91]) and without LVH (9.16 [4.15 to 20.24]
and 25.41 [9.31 to 72.75]) increase the risk. The Cox regression analysis
showed that only the nocturnal BP decrease (OR [95% CI]: 0.97 [0.95 to 0.98],
p = 0.0007) and LVMI (OR [95% ] 1.02 [1.01 to 1.03], p < 0.0001) influenced
in the patients prognosis.
Conclusions: The loss of the depth of blood pressure is the parameter that is
associated with poor CV prognosis in hypertensive patients. The presence of
LVH determined a higher incidence of cardiovascular events. Although eccen-
tric LVH is the most common, the concentric LVH is associated with increased
cardiovascular risk.
PP.36.206 ASSOCIATION BETWEEN EAS INDEX BY TISSUE
DOPPLER IMAGING AND VENTRICULAR STIFFNESS
INDEX OR VENTRICULOARTERIAL INTERACTION
H. Sako, S. Miura, K. Saku. Fukuoka University Hospital, Fukuoka-Japan
Objectives: Aortic stiffening contributes to cardiac afterload, left ventricular
(LV) hypertrophy and substrate of cardiac function. We previously reported that
Eas Index by tissue doppler imaging (TDI) was associated with aortic stiffness
by transesophageal echocardiography and augmentation index. The purpose of
this study was to evaluate the association between Eas index and LV elastance or
ventriculoarterial interaction.
Methods and Results: We evaluated cardiac function by both conventional
echocardiography and TDI velocities from 2 mitral annular sites in consecu-
tive 300 patients. TDI velocities were quantified by Eas index of diastolic and
systolic performance: e’ /(a’xs’). We also examined LV diastolic elastance
index (Ed), arterial elastance index (Ea), LV end-systolic elastance index
(Ees), ventricular- vascular coupling index (10xEa/Ees) and total stiffness
index (10xEdxEa/Ees). The Eas index was significantly correlated with Ed
(r = -0.470, p < 0.0001), Ea (r = -0.198, p = 0.035) and total stiffness index
(r = -0.272, p = 0.003). However, Ees and ventricular-vascular coupling index
were not associated with Eas index. Finally, multivariate logistic regression
analysis showed that plasma levels of brain natriuretic peptide were most
closely correlated with Ed (p = 0.004).
Conclusions: The Eas index for TDI may be a helpful tool for evaluating aortic
stiffness, cardiac afterload and diastolic LV function.
PP.36.207 TISSUE DOPPLER INDEXES OF LEFT VENTRICULAR
SYSTOLIC FUNCTION IN RELATION TO THE
PULSATILE AND STEADY COMPONENTS OF BLOOD
PRESSURE IN A GENERAL POPULATION
T. Kuznetsova1, W. Sakiewicz2, M. Kloch-Badelek3, J. Dhooge1, A. Ryabikov4,
K. Kunicka2, E. Swierblewska2, L. Thijs1, S. Malyutina4, K. Stolarz-
Skrzypek3, K. Kawecka-Jaszcz3, K. Narkiewicz2, J.A. Staessen1. 1University
of Leuven, Leuven-Belgium, 2Medical University of Gdansk, Gdansk- Poland,
3
Jagiellonian University Medical College, Cracow-Poland, 4Institute of Internal
Medicine, Novosibirsk-Russia
Objective: To our knowledge, no population study described the association of
the radial and longitudinal components of left ventricular (LV) strain with blood
pressure (BP) in continuous analyses. We therefore investigated these associa-
tions in subjects randomly recruited from the general population in the frame-
work of the family-based European Project on Genes in Hypertension.
Design and Method: In 303 subjects (51.5% women; mean age, 43.0 year),
using Tissue Doppler Imaging (TDI), we measured:1 end-systolic longitudi-
nal strain (mean, 21.0%) and peak systolic strain rate (SR) (1.29 1/s) from
the basal portion of the LV inferior and posterior free walls;2 and radial stain
(51.1%) and SR (3.40 1/s) of the LV posterior wall. Models included in addi-
tion to covariables and confounders both systolic and diastolic BPs or both
pulse pressure (PP) and mean arterial pressure (MAP). Effect sizes were
expressed per 1-SD increase in BP.
Results: Longitudinal strain (–0.72%; P = 0.03 and –0.76%; P = 0.005), but
not SR, decreased with diastolic BP and MAP. Radial strain (4.5% and –3.5%;
P ≤ 0.001) and SR (0.36 1/s and –0.21 1/s; P ≤ 0.03) independently increased
with systolic BP and decreased with diastolic BP. Accordingly, radial strain
(3.1%; P < 0.0001) and SR (0.22 1/s; P = 0.0007) increased with higher PP, but
were not related to MAP.
Conclusions: In the general population, BP is an independent determinant of
LV systolic function as measured by TDI. Radial function increased with PP,