In some hypertensive patients the left ventricle works inefficiently with a high energy wasting, at the same level of LV mass as hypertensive patients with normal myocardial mechanical efficiency. Those patients feature a high cardiovascular risk phenotype, with concentric LV geometry, systolic dysfunction, and indirect signs of more severe vascular impairment.

Abstract-Left ventricular (LV) mass (LVM) is the most important information requested in hypertensive patients referred for echocardiography. However, LV function also predicts cardiovascular (CV) risk independent of LVM. There is no evidence that addition of LV function significantly improves model prediction of CV risk compared with LVM alone. Thus, composite fatal and nonfatal CV or cerebrovascular events were evaluated in 5380 hypertensive outpatients (2336 women, 298 diabetics, and 1315 obese subjects) without prevalent CV disease (follow-up: 3.5Ϯ2.8 years). We compared 5 risk models using Cox regression and adjusting for age and sex: (1) LV mass normalized for height in meters 2.7 (LVMi); (2) LVMi, concentric LV geometry, by relative wall thickness (Ͼ0.43), ejection fraction, and transmitral diastolic pattern (by thirtiles of mitral deceleration index); (3) LVMi, LV geometry, midwall shortening, and mitral deceleration index thirtiles; (4) as No. 2 with the addition of left atrial dilatation (Ͼ23 mm); and (5) as No. 3 with the addition of left atrial dilatation. Individual hazard functions were compared using receiving operating characteristic curves and z statistics. Areas under the curves increased from 0.60 in the model with the sole LVMi to 0.62 in the others (all P values for differences were not significant). The additional information on systolic and diastolic function decreased the contribution (Wald statistics) of LVMi in the Cox model without improving the model ability to predict CV risk. We conclude that risk models with inclusion of information on LV geometry and systolic and diastolic function, in addition to LVMi, do not improve the prediction of CV events but rather redistribute the impact of individual predictors within the risk variance. (Hypertension. 2010;56:99-104.) Key Words: cardiac mass Ⅲ heart atria Ⅲ cardiovascular risk Ⅲ arterial hypertension Ⅲ prognosis Ⅲ outcome Ⅲ hazard models D espite the most common recommendation to perform echocardiographic examinations in hypertensive patients based on indications that might yield modifications of the management strategy 1,2 and the most recent guidelines that do not list echocardiography in the primary workup for arterial hypertension, 3,4 arterial hypertension remains one of the most frequent indications for echocardiography, especially in countries where the direct cost is not perceived as a direct charge for patients.The substantial reason for echocardiography in arterial hypertension is assessment of left ventricular (LV) mass, based on the broad evidence that LV hypertrophy (LVH) is one of the most important prognostic markers in hypertension, as well as in general populations. 3,4 However, following the reports on LVH, a large number of studies have indicated other echocardiographic markers of cardiovascular risk to be independent of LVH, including LV geometry 5,6 and systolic and diastolic function. [7][8][9][10] The demonstration of independence from LVH is usually obtained using multivariate Cox proportional hazard analysis, whi...

Background and objectives Recent epidemiologic studies have provided evidence for an association between nephrolithiasis and cardiovascular disease, although the underlying mechanism is still unclear. Vascular calcification (VC) is a strong predictor of cardiovascular morbidity and the hypothesis explored in this study is that VC is more prevalent in calcium kidney stone formers (KSFs). The aims of this study were to determine (1) whether recurrent calcium KSFs have more VC and osteoporosis compared with controls and (2) whether hypercalciuria is related to VC in KSFs.Design, setting, participants, & measurements This is a retrospective, matched case-control study that included KSFs attending an outpatient nephrology clinic of the Royal Free Hospital (London, UK) from 2011 to 2014. Ageand sex-matched non-stone formers were drawn from a list of potential living kidney donors from the same hospital. A total of 111 patients were investigated, of which 57 were KSFs and 54 were healthy controls. Abdominal aortic calcification (AAC) and vertebral bone mineral density (BMD) were assessed using available computed tomography (CT) imaging. The prevalence, severity, and associations of AAC and CT BMD between KSFs and non-stone formers were compared.Results Mean age was 47614 years in KSFs and 47613 in non-stone formers. Men represented 56% and 57% of KSFs and non-stone formers, respectively. The prevalence of AAC was similar in both groups (38% in KSFs versus 35% in controls, P=0.69). However, the AAC severity score (median [25th percentile, 75th percentile]) was significantly higher in KSFs compared with the control group (0 [0, 43] versus 0 [0, 10], P,0.001). In addition, the average CT BMD was significantly lower in KSFs (159653 versus 194 648 Hounsfield units, P,0.001). A multivariate model adjusted for age, sex, high BP, diabetes, smoking status, and eGFR confirmed that KSFs have higher AAC scores and lower CT BMD compared with non-stone formers (P,0.001 for both). Among stone formers, the association between AAC score and hypercalciuria was not statistically significant (P=0.86).Conclusions This study demonstrates that patients with calcium kidney stones suffer from significantly higher degrees of aortic calcification than age-and sex-matched non-stone formers, suggesting that VC may be an underlying mechanism explaining reported associations between nephrolithiasis and cardiovascular disease. Moreover, bone demineralization is more prominent in KSFs. However, more data are needed to confirm the possibility of potentially common underlying mechanisms leading to extraosseous calcium deposition and osteoporosis in KSFs.