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Abstract

The severity of blood pressure load is often an unreliable indicator of future cardiovascular (CV) events and the evaluation of subclinal target organ damage (TOD) is an important component in the stratification of global CV risk profile in essential hypertension (EH). Recently, a depressed left ventricular (LV) midwall fractional shortening (MFS) has been showed to be a marker of subclinical impairment of LV function and a predictor of adverse outcome in EH. Aim of the study was to evaluate the relationship between MFS and extracardiac organ damage in a group of 344 untreated hypertensive patients. Left ventricular mass index (LVMI) and function (MFS) were assessed by M-B mode echocardiography (LV hypertrophy LVH= LVMI > 51g/m 2.7). Albuminuria was measured as albumin to creatinine ratio (ACR) in three first morning urine samples. Microalbuminuria (Mi) was defined as an average ACR between 2.38-19 (males) and 2.96-20 (females). Carotid wall geometry was evaluated by US scan, and retinopathy by direct ophthalmoscopy (Keith-Wagener classification). The prevalence of LVH, carotid plaque, Mi, and retinal changes was 46, 25, 13, and 67% respectively. There were no differences as for blood pressure, lipid profile, and smoking habits among groups of patients examinated on the basis of MFS quintiles. Patients in the bottom quintile of MFS showed a higher LVMI (56 ±2.3, 53 ±1.9, 54 ±2, 48 ±1.8 and 48 ±1.8 g/m2.7 respectively; P<0.01) as well as a higher prevalence of LVH (65, 53, 54, 27, and 32%, respectively; P<0.01), especially concentric hypertrophy (65, 45, 36, 15, and 12 %, respectively; P<0.001). Moreover hypertensives with subclinical impairment of LV function, i.e. those in the bottom quintile of MFS, showed early signs of extracardiac damage, namely increased carotid surface area (CSA) (19.3 ±2.1, 15,3 ±0.9, 16.9 ±2.3, 14.7 ±1.3, and 13.6 ±0.9 respectively; P<0.01) and ACR (3.1 ±0.9, 1.5 ±0.4, 1.6 ±0.4, 0.9 ±0.2, and 0.9 ±0.2, respectively; P=0.01), a higher prevalence of microalbuminuria (28, 16, 15, 3, and 7%, respectively; P<0.05) and retinopathy (P=0.02) as compared to patients in the other MFS quintiles. Furthermore, MFS was inversely correlated to mean blood pressure (r=-0.15, P<0.05) and signs of early TOD, namely LVMI (r=-0.23, P<0.01), ACR (r=-0.2, P<0.01), and CSA (r=-0.25, P<0.02). In conclusion, hypertensive patients with depressed MFS show a higher prevalence of LVH and early signs of extracardiac vascular damage. These findings strengthen the role of MFS as an indicator of subclinical CV disease. The evaluation of MFS can be helpful in the stratification of CV risk in patients with EH.

Target Organ Damage, Essential Hypertension, Left Ventricular Function
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© American Journal of Hypertension, Ltd. 2002
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