Prognostic Value of Echocardiography in Hypertensive Versus Nonhypertensive Participants From the General Population
Prognostic Value of Echocardiography in Hypertensive Versus Nonhypertensive Participants From the General Population
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DOI：
10.1161/hypertensionaha.117.10674
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发表时间：
2018-04-01
期刊：
影响因子：
8.3
通讯作者：
Biering-Sorensen, Tor
中科院分区：
文献类型：
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作者：
Modin, Daniel;Biering-Sorensen, Sofie Reumert;Biering-Sorensen, Tor
高血压可能是最重要的心血管危险因素。很少有研究评估超声心动图对高血压患者的预后价值。本研究探讨了将超声心动图参数添加到有高血压和无高血压的普通人群中确定的危险因素的增量预后价值。共有1294名普通人群接受了健康检查和超声心动图，包括二维斑点跟踪。结果是缺血性心脏病和心力衰竭的综合结果。高血压患病率为38.3%。在中位随访12.5年（四分位数间距9.4-12.8年）期间，222名参与者（17.2%）出现了上述结果。在这222例事件中，145例（65%）发生在高血压参与者中，而77例（35%）发生在非高血压个体中，相应的发病率分别为32/（1000人年）和8/（1000人年）。随访率为100%。在多变量调整后，只有左心室质量指数预测高血压个体的预后，而只有整体纵向应变预测非高血压个体的预后。在高血压患者中，左室质量指数的预后价值逐渐增加到SCORE和异常心电图状态。在非高血压个体中，总纵应变的预后价值随着SCORE和异常心电图状态的增加而增加。超声心动图对一般人群心血管预后的预测价值因高血压而改变。在高血压患者中，除了确定的危险因素外，左心室质量指数增加了增量预后价值。在非高血压个体中，除了确定的危险因素外，总体纵向应变增加了增量预后价值。
Hypertension may be the most significant cardiovascular risk factor. Few studies have assessed the prognostic value of echocardiography in hypertensive individuals. This study examines the incremental prognostic value of adding echocardiographic parameters to established risk factors in individuals from the general population with and without hypertension. A total of 1294 individuals from the general population underwent a health examination and an echocardiogram including 2-dimensional speckle tracking. Outcome was a composite of ischemic heart disease and heart failure. The prevalence of hypertension was 38.3%. During a median follow-up of 12.5 years (interquartile range, 9.4-12.8 years), 222 participants (17.2%) developed the outcome. Out of these 222 events, 145 (65%) occurred in hypertensive participants, whereas 77 (35%) occurred in nonhypertensive individuals, corresponding to an incidence rate of 32/(1000xperson-years) and 8/(1000xperson-years), respectively. Follow-up was 100%. After multivariable adjustment, only left ventricular mass index predicted the outcome in hypertensive individuals, whereas only global longitudinal strain predicted the outcome in nonhypertensive individuals. In hypertensive individuals the prognostic value of left ventricular mass index was incremental to SCORE and abnormal ECG status. In nonhypertensive individuals the prognostic value of global longitudinal strain was incremental to SCORE and abnormal ECG status. The prognostic value of echocardiography in predicting cardiovascular outcomes in the general population is altered by hypertension. In hypertensive individuals, left ventricular mass index added incremental prognostic value in addition to established risk factors. In nonhypertensive individuals, global longitudinal strain added incremental prognostic value in addition to established risk factors.