PERSISTENCE OF LEFT-VENTRICULAR HYPERTROPHY IS A STRONGER INDICATOR OF CARDIOVASCULAR EVENTS THAN BASE-LINE LEFT-VENTRICULAR MASS OR SYSTOLIC PERFORMANCE - 10 YEARS OF FOLLOW-UP

Objective Left ventricular hypertrophy (LVH) and depressed left ventri cular performance have been shown to be associated to an adverse progn osis in hypertensive patients. It has not been established, however, w hether, during chronic antihypertensive treatment, the increased cardi ovascular risk is more strictly related to the presence of LVH or of a low left ventricular performance, Design and methods A total of 215 p atients with uncomplicated hypertension (129 males, 86 females; age ra nge 18-70 years, mean +/- SD 45 +/- 11) underwent an echocardiographic evaluation of left ventricular anatomy and function. In 151 patients (87 males, 64 females; age range 18-70 years, mean 45 +/- 10.4) the ec hocardiogram was repeated on average 10 +/- 1 years after the initial study. The presence of LVH (left ventricular mass index >134 g/m(2) in males and 110 g/m(2) in females) and the midwall left ventricular sho rtening/end-systolic stress relationship were prospectively analysed a s predictors of cardiovascular non-fatal events (n = 23) in patients w ho were seen at follow-up. Results The incidence of non-fatal cardiova scular events was greater in patients with LVH (n = 17 P < 0.0001) and in those with a lower midwall performance (n = 14, P < 0.01) at basel ine. At follow-up, the incidence of non-fatal cardiovascular events wa s significantly greater in patients without a reduction in the left ve ntricular mass index, after adjusting for traditional risk factors (re lative risk 3.52 versus 1.38 in patients with persistence and regressi on of LVH, respectively; P < 0.01). The baseline midwall fractional sh ortening was lower in patients with both persistence or regression of LVH (analysis of variance, P < 0.0001) than in patients with a normal left ventricular mass index. In logistic analysis, the left ventricula r mass index at follow-up and age were independent determinants of non -fatal cardiovascular events (P < 0.001); without the left ventricular mass index at follow-up, this analysis showed that age, systolic bloo d pressure at follow-up and baseline midwall fractional shortening wer e independent determinants of non-fatal cardiovascular events. Conclus ions Our results suggest that lack of regression of LVH is a stronger indicator of cardiovascular risk than a depressed baseline midwall lef t ventricular performance.