Left ventricular longitudinal systolic dysfunction is an independent marker of cardiovascular risk in patients with hypertension.
BACKGROUND
To explore the prognostic value of left ventricular (LV) longitudinal systolic dysfunction in patients with hypertension.


METHODS
In 156 hypertensive subjects, LV longitudinal systolic function was assessed by echocardiographic measurement of M-mode left atrioventricular plane displacement (AVPD) and Tissue Doppler (TD)-derived mitral annulus peak systolic velocity (Sm). Patients were followed for development of the following cardiovascular events: congestive heart failure requiring hospitalization, new-onset angina, nonfatal myocardial infarction, coronary revascularization procedures, transient ischemic attack, nonfatal stroke, and cardiovascular death.


RESULTS
Over a follow-up of 23.3 +/- 5.4 months, 24 patients had 29 events. Both longitudinal systolic indices were predictive of outcome (hazard ratios: AVPD, 0.24, P < 0.001; Sm, 0.22; P < 0.001). AVPD < or = 11.4 mm (75.0% sensitivity and 53.8% specificity) and Sm < or = 8.9 cm/s (79.2% sensitivity and 61.4% specificity) were identified as the best cutoffs for the prediction of cardiovascular events (area under curve: AVPD, 0.66, P < 0.01; Sm, 0.71; P < 0.0001). Compared to conventional indices of circumferential systolic function, AVPD and Sm showed similar overall diagnostic performance, but higher sensitivity and lower specificity. Coexistence of longitudinal and circumferential systolic dysfunction was associated with the worst prognosis (P < 0.0001). Multivariate analysis confirmed an independent association of longitudinal indices with clinical outcome, incremental to circumferential systolic impairment, and other confounding variables.


CONCLUSIONS
Longitudinal systolic dysfunction is an independent marker of cardiovascular risk in hypertensive patients. Despite similarity in predictive accuracy, longitudinal indices are more sensitive but less specific than circumferential indices for the prediction of cardiovascular events in these subjects.
Ballo
Piercarlo
P
Cardiology Operative Unit, S. Andrea Hospital, La Spezia, Italy. pcballo@tin.it
Barone
Daniele
D
Bocelli
Arianna
A
Motto
Andrea
A
Mondillo
Sergio
S
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D016757:Death, Sudden, Cardiac; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D011379:Prognosis; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis; D018487:Ventricular Dysfunction, Left / Q000150:complications*