Aim To evaluate changes in left ventricular (LV) systolic function by LV myocardial global longitudinal strain (GLS) and global strain rate (GSR) in patients with arterial hypertension (AH) and based on the effectiveness of blood pressure (BP) control in a Russian population sample of individuals older than 55 years.Materials and methods This cross-sectional study was a population-based cohort study (HAPIEE, Novosibirsk). LV myocardial GLS and GSR were studied by echocardiography in a random sample (n=1004, 55–84 years). Statistical analysis was performed with multivariate models of logistic regression.Results AH prevalence in the study sample was 78.4 %. Mean GLS was 19.1 % (SD, 4.07), which was less for men than for women (p=0.001). Mean GSR was 0.86 s-1 (SD, 0.19) and was not different between men and women. In individuals with AH, the GLS absolute value was lower than in normotensive people (18.8 %; SD, 4.04 vs. 20.2 %; SD, 4.03, p˂0.001); these differences remained irrespective of the age, gender, body weight index (BWI) (p=0.027), and LV mass index (p=0.05). When people with AH were divided into groups, the lowest GLS absolute values were observed among “ineffectively treated” or not receiving any therapy individuals (p<0.001 vs. normotensive group). AH 1.6 times increased the risk of LV GLS decrease. In individuals with AH, the GSR absolute value was lower than in normotensive people (– 0.85 s-1 (SD, 0.19) vs.– 0.92 s-1 (SD, 0.18), p<0.001); this difference remained in multivariate models. The lowest GSR absolute values were observed in the “ineffectively treated“ group irrespective of the gender, age, and BWI (p=0.036 vs. normotensive group). AH doubled the risk of LV GSR decrease, which could be partially explained by the contribution of BWI and myocardial mass index.Conclusion In this population sample, LV GLS and GSR were independently associated with AH. The lowest GLS and GSR values were observed for ineffectively treated” individuals with AH, which may reflect an early decline of LV systolic function with inadequate control of AH.
Objective. The contribution of left ventricular hypertrophy (LVH) to the risk of cardiovascular disease (CVD) and mortality is well established but the prognostic role of structural LVH patterns in the population is ambiguous. The aim of the work — to study the prognostic value of geometric variants of LVH in a 12-year cohort study.Design and methods. The study design—cross-sectional and cohort studies—based on the material from a series of echocardiographic examinations (Echo) in general population samples in Novosibirsk city. The cohort analysis included 2006 men and women 25–64 years old with special concerns about LVH (according to the criterion of increased myocardial mass index (IMM)) and for geometric variants of LVH. The mean follow-up period was of 12,2 years (SD = 3,2) and 220 endpoints (90 CVD deaths) were registered. The risk of incident fatal and nonfatal CVD and death was assessed by Cox regression analysis.Results. In the studied sample, the prevalence of LVH was of 22,8% (lower in men than in women, p < 0,001). Population-specific criteria for increased IMM were 124 g/m2 (men) and 100 g/m2 (women). LVH independently increased the 12-year risk of myocardial infarction (MI) by 1,8 times, fatal MI — by 2 times, fatal CVD — by 1,8 times and all-cause mortality — by 1,6 times. Concentric and disproportional septal forms of LVH (DS LVH) had the most unfavorable prognosis; 40–80% of the excess-risk of CVD and death in these variants was explained by myocardial mass, but the impact of DS LVH was maintained independently of left ventricle myocardial mass. The pattern of segmental LVH (based on additional 2D measurement of the thickest segment) increased the risk of CVD and mortality by 1,9–2,5 times in men.Conclusions. In a population sample aged 25–64 years (Novosibirsk), LVH independently increased the 12-year risk of MI, fatal CVD and death from all causes by 1,6–2 times. Among the geometric types of LVH, concentric and DS LVH had the most unfavorable prognostic value; the impact of DS LVH to the risk of fatal CVD remained significant independently of myocardial mass. The pattern of segmental LVH based on additional 2D Echo measurements, increased the risk of CVD and death by 2–2,5 times. CVD risk and mortality levels depending on the LVH patterns suggest a number of preventive measures against cardiovascular complications and mortality.
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