NEW YORK (Reuters Health), Dec 10 - Estimates of left atrial filling pressure, drawn from Doppler studies of the left ventricle, can strongly predict a first cardiac event in hypertensive patients, according to a report in the November 26 European Heart Journal.
The ratio between early filling velocity on transmitral Doppler (E) and early relaxation velocity on tissue Doppler (E') is known to have prognostic value in established and advanced cardiac disease. Now, researchers have found, this ratio is "a simple, effective tool" in hypertensives without established heart disease, too, in whom it "provides additional information over and above that of clinical risk factor assessment."
In 816 patients in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), Dr. Andrew S. P. Sharp from St. Mary's Hospital and Imperial College London, and colleagues sought to compare the E/E' ratio to traditional echocardiographic measures of risk. Doppler tracings from all left ventricular regions were available for all subjects.
During a mean follow-up period of 4.2 years, tissue Doppler E/E' was the only significant predictor of first cardiac events, the authors report. This relationship persisted after adjustment for age, gender, diabetes, and systolic blood pressure.
In multivariate models, E/E' remained a powerful predictor of primary cardiac events after adjustment for the 10-year coronary heart disease Framingham risk score, whereas the Framingham score did not significantly predict outcomes.
Moreover, the investigators say, E/E' was the only significant predictor of risk in another model that included traditional echocardiographic measures of risk.
The highest quartile of E/E' had 2.42-times the risk of cardiac events as the lowest quartile of E/E'.
"The current study is the first to prospectively demonstrate the ability of the E/E' ratio to predict primary cardiac events in a hypertensive population without established cardiac disease," the researchers note.
Eur Heart J 2009.
Last Updated: 2009-12-09 17:45:08 -0400 (Reuters Health)
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