BACKGROUND: The prognostic value of electrocardiographic left ventricular hypertrophy (ECG-LVH) in resistant hypertension (RH) is unknown. The aim was to evaluate the importance of baseline and serial changes in ECG-LVH as predictors of cardiovascular morbidity and mortality in patients with RH. METHODS: At baseline and during follow-up, 552 resistant hypertensive patients had 3 ECG-LVH criteria obtained: Sokolow-Lyon, Cornell voltage, and Cornell voltage-duration product. Primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause and cardiovascular mortalities. Total strokes and coronary heart disease (CHD) events were secondary end points. Multiple Cox regression assessed the associations between time-varying ECG-LVH and subsequent end points. RESULTS: After a median follow-up of 4.8 years, 70 patients died, 46 from cardiovascular causes; and 109 total cardiovascular events occurred, 46 strokes, and 44 CHD events. After adjustment for several cardiovascular risk factors, baseline Cornell voltage and product, but not Sokolow-Lyon voltage, were independent predictors of the composite end point and of all-cause and cardiovascular mortalities. Reductions of all ECG-LVH criteria were protective factors for the composite end point: a 1-SD (1.1 mV) reduction in Sokolow-Lyon voltage was associated with a 35% lower risk (95% CI 10%-53%) of cardiovascular events, whereas prevention or regression of Cornell product LVH criterion implied a 40% lower risk (95% CI 11%-60%). Baseline and serial changes in Sokolow-Lyon voltage were independent predictors of strokes, whereas Cornell voltage was predictive of CHD events. CONCLUSIONS: Baseline and serial changes in ECG-LVH predict cardiovascular morbidity and mortality in RH patients. Antihypertensive treatment targeted at regression or prevention of ECG-LVH may improve prognosis. 2010 Mosby, Inc. All rights reserved.
BACKGROUND: The prognostic value of electrocardiographic left ventricular hypertrophy (ECG-LVH) in resistant hypertension (RH) is unknown. The aim was to evaluate the importance of baseline and serial changes in ECG-LVH as predictors of cardiovascular morbidity and mortality in patients with RH. METHODS: At baseline and during follow-up, 552 resistant hypertensivepatients had 3 ECG-LVH criteria obtained: Sokolow-Lyon, Cornell voltage, and Cornell voltage-duration product. Primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause and cardiovascular mortalities. Total strokes and coronary heart disease (CHD) events were secondary end points. Multiple Cox regression assessed the associations between time-varying ECG-LVH and subsequent end points. RESULTS: After a median follow-up of 4.8 years, 70 patients died, 46 from cardiovascular causes; and 109 total cardiovascular events occurred, 46 strokes, and 44 CHD events. After adjustment for several cardiovascular risk factors, baseline Cornell voltage and product, but not Sokolow-Lyon voltage, were independent predictors of the composite end point and of all-cause and cardiovascular mortalities. Reductions of all ECG-LVH criteria were protective factors for the composite end point: a 1-SD (1.1 mV) reduction in Sokolow-Lyon voltage was associated with a 35% lower risk (95% CI 10%-53%) of cardiovascular events, whereas prevention or regression of Cornell product LVH criterion implied a 40% lower risk (95% CI 11%-60%). Baseline and serial changes in Sokolow-Lyon voltage were independent predictors of strokes, whereas Cornell voltage was predictive of CHD events. CONCLUSIONS: Baseline and serial changes in ECG-LVH predict cardiovascular morbidity and mortality in RH patients. Antihypertensive treatment targeted at regression or prevention of ECG-LVH may improve prognosis. 2010 Mosby, Inc. All rights reserved.
Authors: Juan Carlos Yugar-Toledo; Heitor Moreno Júnior; Miguel Gus; Guido Bernardo Aranha Rosito; Luiz César Nazário Scala; Elizabeth Silaid Muxfeldt; Alexandre Alessi; Andrea Araújo Brandão; Osni Moreira Filho; Audes Diógenes de Magalhães Feitosa; Oswaldo Passarelli Júnior; Dilma do Socorro Moraes de Souza; Celso Amodeo; Weimar Kunz Sebba Barroso; Marco Antônio Mota Gomes; Annelise Machado Gomes de Paiva; Eduardo Costa Duarte Barbosa; Roberto Dischinger Miranda; José Fernando Vilela-Martin; Wilson Nadruz Júnior; Cibele Isaac Saad Rodrigues; Luciano Ferreira Drager; Luiz Aparecido Bortolotto; Fernanda Marciano Consolim-Colombo; Márcio Gonçalves de Sousa; Flávio Antonio de Oliveira Borelli; Sérgio Emanuel Kaiser; Gil Fernando Salles; Maria de Fátima de Azevedo; Lucélia Batista Neves Cunha Magalhães; Rui Manoel Dos Santos Póvoa; Marcus Vinícius Bolívar Malachias; Armando da Rocha Nogueira; Paulo César Brandão Veiga Jardim; Thiago de Souza Veiga Jardim Journal: Arq Bras Cardiol Date: 2020 May-Jun Impact factor: 2.000
Authors: Rodrigo C Santos; Ana Paula C de Faria; Natália R Barbaro; Rodrigo Modolo; Silvia E Ferreira-Melo; José R Matos-Souza; Otávio R Coelho; Juan C Yugar-Toledo; Vanessa Fontana; David Calhoun; Heitor Moreno Journal: Eur J Clin Pharmacol Date: 2013-11-24 Impact factor: 2.953