Left ventricular diastolic dysfunction independent predictor of MACE in hypertensive patients

China: Left ventricular diastolic dysfunction (LVDD) is strongly associated with the development of major adverse cardiac events (MACE) in hypertension patients, states an article published in the BMC Cardiovascular Disorders.

Dan Zhou, Guangdong Cardiovascular Institute, People's Republic of China, and colleagues conducted the study to evaluate LVDD in a community hypertension cohort study and assess the effect of LVDD on MACE.

Globally, an estimated 26% of the world's population (972 million people) has hypertension. Hypertension is a significant contributory factor to the development of major adverse cardiac events (MACE). Long-time chronic hypertension may lead to Left ventricular diastolic dysfunction and increase cardiovascular risk but the effect of LVDD, detected by new guidelines, on major adverse cardiac events is unknown in hypertensive patients without known cardiovascular disease.

Researchers studied 283 asymptomatic non-ischemic patients with hypertension who had baseline echocardiogram between 2012 and 2014. Patients were followed for MACE (myocardial infarction, coronary revascularization procedures, heart failure, stroke, all-cause mortality) with a mean follow-up of 5.4 years. A Cox proportional hazards model was used to assess the association of LVDD with MACE.

Key findings of the study,

• At baseline, 35 of the 283 hypertensions were diagnosed with LVDD (12.3%) and 25 patients were women (15.5%). Women had a higher frequency of LVDD than men (8%)

• During follow-up, there were 26.6% of patients suffering from MACE in the LVDD group at baseline, and 9.9% of patients suffering from MACE in the group with normal diastolic function.

• In multivariable Cox regression analyses, LVDD was a stronger predictor of MACE (HR: 2.5) than the E/e′ ratio (HR: 1.13).

The authors conclude that the study findings showed LVDD as an independent predictor of MACE in hypertension patients, independent of separated diastolic function, LVH, and clinical parameters. The prevalence of LVDD was 12.3% in the baseline. Women had worse LV diastolic function and a higher proportion of LVDD in the baseline.

Specific LVDD definition may help differentiate patients at higher risk. It is very important to evaluate diastolic function in community hypertensive individuals. Further studies are necessary to explore the factors of reversing LVDD and the association with cardiac events, the authors suggested.

Reference:

Zhou, D., Yan, M., Cheng, Q. et al. Prevalence and prognosis of left ventricular diastolic dysfunction in community hypertension patients. BMC Cardiovasc Disord 22, 265 (2022). https://doi.org/10.1186/s12872-022-02709-3