Author + information
- Brett Izzo,
- Eric Farber-Eger,
- Evan Brittain and
- Quinn Wells
Background: Cardiac remodeling in hypertensive heart disease classically involves the development of left ventricular hypertrophy (LVH) in response to increased wall stress with some patients progressing to dilated cardiomyopathy (DCM). There is uncertainty regarding whether hypertension (HTN) alone can directly cause DCM without antecedent LVH or myocardial infarction. We assessed the frequency and pattern of cardiac remodeling among hypertensive subjects in a large Electronic Health Record (EHR)-based clinical cohort with longitudinal transthoracic echocardiographic (TTE) data.
Hypothesis: We hypothesized that progression directly to otherwise unexplained DCM without prior LVH would be uncommon among hypertensive subjects.
Methods: This retrospective study included all subjects (N=91,376) at a large medical center who had undergone TTE performed between 1998 and 2015. A normal TTE was defined as normal ejection fraction without LVH or DCM based on American Society of Echocardiography criteria. We assessed longitudinal patterns of remodeling among subjects with HTN, greater than or equal to two TTEs and a normal baseline TTE.
Results: Complete longitudinal TTE data were available for 25,066 subjects, of which 7,027 (with 60,064 TTEs) met inclusion criteria. Subjects were 84% white, 12% black and 63% female. The median age was 58.4 years [IQR 46.4-68.9 years] at time of first TTE. The majority of subjects (84%) experienced no pathologic remodeling during a median follow-up of 2.5 years [IQR 0.7-5.2 years]. Over a median time of 2.8 years [IQR 1.4-5.3 years; range 0.5-15.1 years], 1,065 (15%) subjects progressed to LVH and 39 (0.6%) proceeded directly to DCM without antecedent LVH. Among the latter group, DCM was attributable to interval events other than hypertension in all cases (myocardial infarction, n=17; valvular heart disease, n=8; critical illness, n=3; other, n=11).
Conclusions: Progression directly to DCM without prior LVH is uncommon among hypertensive subjects in a large cohort referred for TTE. While these data should be interpreted within the context of limitations of EHR-derived data, they call into question the assertion that hypertension leads directly to DCM.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Markers of Prognosis Associated With Elevated Blood Pressure
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1234-035
- 2017 American College of Cardiology Foundation