European Heart Journal Advance Access originally published online on February 2, 2005
European Heart Journal 2005 26(9):921-927; doi:10.1093/eurheartj/ehi112
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Interaction between vascular dysfunction and cardiac mass increases the risk of cardiovascular outcomes in essential hypertension
1Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine ‘G. Salvatore’, University Magna Græcia of Catanzaro, Italy
2Internal Medicine and Internal Medicine Unit, University Magna Græcia of Catanzaro, Italy
Received 7 August 2004; revised 22 November 2004; accepted 9 December 2004; online publish-ahead-of-print 2 February 2005.
* Corresponding author: Department of Medicina Sperimentale e Clinica, Policlinico Mater Domini – Via Tommaso Campanella, 88100 Catanzaro, Italy. Tel: +39 0961 712264; fax: +39 0961 775564. E-mail address: perticone{at}unicz.it
Aims To investigate the additive prognostic impact of both forearm endothelial dysfunction and left ventricular mass (LVM) for future cardiovascular events.
Methods and results We enrolled 324 Caucasian, never treated, hypertensive outpatients. Endothelial function, by intra-arterial infusion of acetylcholine (ACh), and echocardiographic LVM were investigated. Patients were divided into tertiles on the basis of their increase in ACh-stimulated forearm blood flow (FBF) and LVM indexed by body surface area (LVMI). Cardiovascular events assessed were: fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, transient cerebral ischaemic attack, unstable angina, coronary revascularization procedures, and symptomatic aorto-iliac occlusive disease. During a mean follow-up of 45.2±23.6 months, there were 47 new cardiovascular events (3.8 events/100 patient-years). The event rate was 6.8, 2.8, and 1.6% in the tertiles of ACh-stimulated FBF (log-rank test, P=0.0009), and 1.4, 3.4, and 6.6% in the tertiles of LVMI (log-rank test, P=0.0002), respectively. Besides, a significant interaction was documented between FBF and LVMI. In fact, the cardiovascular risk increases up to 11.4% in patients with low FBF and high LVMI.
Conclusion For the first time, we demonstrate that the co-existence of LVH and endothelial dysfunction in hypertensive patients increases significantly the risk of subsequent cardiovascular events.
Key Words: Atherosclerosis • Endothelium • Hypertension • Cardiac hypertrophy • Prognosis
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