title: Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy.
abstract: OBJECTIVE
  We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy.
  
  
  BACKGROUND
  Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients.
  
  
  METHODS
  Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months.
  
  
  RESULTS
  Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043).
  
  
  CONCLUSIONS
  Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Gabriel Wk
authors.initials: GW
authors.lastname: Yip
authors.forename: Angela Ym
authors.initials: AY
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Pik Yuk
authors.initials: PY
authors.lastname: Ho
authors.forename: Mui Kiu
authors.initials: MK
authors.lastname: Tse
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D015331:Cohort Studies; D003643:Death; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000401:mortality*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality