Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:107-14 - Vol. 68 Num.02 DOI: 10.1016/j.rec.2014.03.023

Prognostic Value of Exercise-induced Left Ventricular Systolic Dysfunction in Hypertensive Patients Without Coronary Artery Disease

Oscar Prada-Delgado a,, Eduardo Barge-Caballero a, Jesús Peteiro a, Alberto Bouzas-Mosquera a, Rodrigo Estévez-Loureiro a, Gonzalo Barge-Caballero a, Manuel López-Pérez a, Nicolás Vázquez-González a, Alfonso Castro-Beiras a

a Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain

Keywords

Systemic arterial hypertension. Exercise echocardiography. Left ventricular dysfunction. Heart failure.

Abstract

Introduction and objectives

We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease.

Methods

From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure.

Results

Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio = 3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio = 5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio = 8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio = 5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio = 6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio = 4.5; 95% confidence interval, 1.2-16.0).

Conclusions

In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease.

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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