The voltage of R wave in lead aVL improves risk stratification in hypertensive patients without ECG left ventricular hypertrophy

Verdecchia, Paolo; Angeli, Fabio; Cavallini, Claudio; Mazzotta, Giovanni; Repaci, Salvatore; Pede, Silvia; Borgioni, Claudia; Gentile, Giorgio; Reboldi, Gianpaolo

doi:10.1097/hjh.0b013e32832c0031

Cited by 44 publications

(28 citation statements)

References 39 publications

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“…With regard to RaVL, a very recent prospective study (18) focused on the R wave voltage in lead aVL as being rather closely associated with left ventricular mass (LVM), and additionally being predictive of incident cardiovascular events in hypertensive patients. In this study, we also used this electrophysiological parameter to study the association between LVM and thyroid function.…”

Section: Discussionmentioning

confidence: 99%

Associations between cardiovascular risk, insulin resistance, β-cell function and thyroid dysfunction: a cross-sectional study in She ethnic minority group of Fujian Province in China

Chen¹,

Wu²,

Lin³

et al. 2010

European Journal of Endocrinology

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Objective: To investigate the associations between cardiovascular risk, insulin resistance (IR), b-cell function and thyroid dysfunction in She ethnic minority group in China. Methods: We enrolled 5080 participants of She ethnicity in this analysis eventually. We measured serum TSH and thyroid peroxidase antibody (TPOAb) concentrations, blood glucose and insulin levels in both fasting and 2-h postprandial states, serum lipid levels, blood pressure (BP), brachial-ankle pulse wave velocity (baPWV), electrophysiological parameters, including T peak -T end interval (T p-e ), QT interval and height of the R wave in lead aVL (RaVL), and anthropometric parameters. Results: The total prevalence of thyroid dysfunction in this population is 12.1%. Hyperthyroid subjects had shorter T p-e interval and QT interval in electrocardiogram (ECG), while hypothyroid subjects had shorter T p-e interval and longer QT interval in ECG than euthyroid subjects. Neither hyperthyroid nor hypothyroid subjects showed significant difference in BP, pulse pressure, and baPWV compared with euthyroid subjects. RaVL was slightly higher in hyperthyroid subjects, though the difference did not reach statistical significance (PZ0.08). Subjects with TSH!0.3 mIU/l had higher blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and b-cell function (HOMA-b), whereas subjects with TSHO10 mIU/l had lower insulin, HOMA-IR, and HOMA-b than the reference group. There was a significant negative correlation, albeit weak, between TSH and HOMA-IR, HOMA-b after adjustment for confounding factors. Conclusions: Hypothyroid subjects may carry higher cardiovascular risk than euthyroid subjects. Moreover, IR and b-cell function are inversely correlated with TSH, which may be explained by the decreasing insulin-antagonistic effects of thyroid hormones along with increasing TSH.

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Section: Discussionmentioning

confidence: 99%

Associations between cardiovascular risk, insulin resistance, β-cell function and thyroid dysfunction: a cross-sectional study in She ethnic minority group of Fujian Province in China

Chen¹,

Wu²,

Lin³

et al. 2010

European Journal of Endocrinology

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“…Moreover, we favored the use of a very widespread ECG index of hypertrophy, that is, the SokolovLyon index. Because of its known limitations, like, for example, the interaction with body mass index, 18 we also used the amplitude of R wave in lead aVL, proposed recently by Verdecchia et al 16 as a simple marker of cardiovascular risk. The latter indicator appears to play a predominant role in the Cornell voltage, another ECG marker of LVH, 16 less dependent on body mass index.…”

Section: Discussionmentioning

confidence: 99%

“…Because of its known limitations, like, for example, the interaction with body mass index, 18 we also used the amplitude of R wave in lead aVL, proposed recently by Verdecchia et al 16 as a simple marker of cardiovascular risk. The latter indicator appears to play a predominant role in the Cornell voltage, another ECG marker of LVH, 16 less dependent on body mass index. 18 In addition, as we and other groups have shown, 10,19,20 natriuretic peptides are also able to spot LVH in hypertension.…”

Section: Discussionmentioning

confidence: 99%

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N-Terminal Pro-Brain Natriuretic Peptide

et al. 2011

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Abstract-Natriuretic peptides are controregulatory hormones associated with cardiac remodeling, namely, left ventricular hypertrophy and systolic/diastolic dysfunction. We intended to address the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in hypertension. We prospectively studied the relationship between plasma NTproBNP and all-cause mortality in 684 hypertensive patients with no history or symptoms of heart failure referred for hypertension workup in our institution from 1998 to 2008. After a mean duration of 5.7 years, we observed 40 deaths (1.04 deaths per 100 patients per year). After adjustment for traditional cardiovascular risk factors, including ambulatory blood pressure and serum creatinine, the risk for all-cause mortality more than doubled with each increment of 1 log NT-proBNP (hazard ratio: 2.33 [95% CI: 1.36 to 3.96]). The risk of death of patients with plasma NT-proBNP Ն133 pg/mL (third tertile of the distribution) was 3.3 times that of patients with values Ͻ50.8 pg/mL (first tertile; hazard ratio: 3.30 [95% CI: 0.90 to 12.29]). This predictive value was independent of, and superior to, that of 2 ECG indexes of left ventricular hypertrophy, the Sokolov-Lyon index and the amplitude of the R wave in lead aVL. In addition, it persisted in patients without ECG left ventricular hypertrophy, which allowed refining risk stratification in this relatively low-risk patient category. In this large sample of hypertensive patients, plasma NT-proBNP appeared as a strong prognostic marker. This performance, together with the ease of measurement, low cost, and widespread availability of NT-proBNP test kits, should prompt a wide use of this marker for risk stratification in hypertension. (Hypertension. 2011;57:702-709.)Key Words: hypertension Ⅲ NT-proBNP Ⅲ survival Ⅲ risk stratification Ⅲ left ventricular hypertrophy I n hypertension, detection of cardiac damages is critical for risk stratification. 1 This is usually done by searching for left ventricular hypertrophy (LVH), a major predictor of cardiovascular events. 2,3 However, in clinical practice, LVH detection is subject to various limitations. ECG is recommended by most guidelines but has a poor sensitivity and is rarely performed in clinical practice. 4 Echocardiography is extensively used but is time consuming, expensive, and not always feasible for technical reasons. The cost-effectiveness of its systematic use in hypertensive patients is still widely debated. 5 Thus, there is still room for new cardiac markers to be used for risk stratification.In response to volume expansion and pressure load, ventricular myocytes release a cardiac hormone, the B-type natriuretic peptide (BNP), together with its amino-terminal fragment, the N-terminal proBNP (NT-proBNP). 6 BNP and NT-proBNP are strong prognostic markers in advanced stages of cardiac diseases like heart failure 7 or coronary disease. 8 They are also closely related to cardiac geometry and mass, 9 and we have recently demonstrated the good performance of plasma NTproBNP for t...

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“…Так, например, в недавно проведенном проспективном исследовании изучалась взаимосвязь вольтажа зубца R в отведении aVL, напрямую связан-ного с массой левого желудочка, с сердечно-сосуди-стыми катастрофами. Показано, что ассоциация с сер-дечно-сосудистыми катастрофами наблюдалась, даже если АГ не сопровождалась электрокардиографиче-скими признаками ГЛЖ (9% возрастание риска при уве-личении зубца R на каждые 0,1 мВольт [9]). Кроме того, в недавно проведенном ретроспективном исследова-нии более чем 35000 пациентов с нормальным или по-вышенным уровнем АД и с нормальной фракцией вы-броса левого желудочка у 46% пациентов было вы-явлено нарушение геометрии левого желудочка (у 35% -концентрическое ремоделирование желудочка, у 11% -ГЛЖ), что ассоциировалось с двукратным уве-личением риска смерти от всех причин по сравнению с больными с нормальной геометрией левого желудочка [10].…”

Section: гипертрофия миокарда левого желудочкаunclassified

Сardioprotection in Patients With Hypertension – The Role of Losartan

Чукаева¹,

Spiryakina²

2013

Racionalʹnaâ farmakoterapiâ v kardiologii

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The voltage of R wave in lead aVL improves risk stratification in hypertensive patients without ECG left ventricular hypertrophy

Cited by 44 publications

References 39 publications

Associations between cardiovascular risk, insulin resistance, β-cell function and thyroid dysfunction: a cross-sectional study in She ethnic minority group of Fujian Province in China

Associations between cardiovascular risk, insulin resistance, β-cell function and thyroid dysfunction: a cross-sectional study in She ethnic minority group of Fujian Province in China

N-Terminal Pro-Brain Natriuretic Peptide

Сardioprotection in Patients With Hypertension – The Role of Losartan

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