title: Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease.
abstract: OBJECTIVE
  We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease.
  
  
  METHODS
  From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure.
  
  
  RESULTS
  Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio=3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio=5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio=8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio=5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio=6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio=4.5; 95% confidence interval, 1.2-16.0).
  
  
  CONCLUSIONS
  In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease.
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain. Electronic address: Oscar.Prada.Delgado@sergas.es.
authors.forename: Oscar
authors.initials: O
authors.lastname: Prada-Delgado
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barge-Caballero
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Pérez
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez-González
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D001794:Blood Pressure; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D004452:Echocardiography; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Disfunción ventricular izquierda; Ecocardiografía de ejercicio; Exercise echocardiography; Heart failure; Hipertensión arterial sistémica; Insuficiencia cardiaca; Left ventricular dysfunction; Systemic arterial hypertension