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182 Tissue doppler E’ velocity and E/e’ predict 19-year cardiovascular mortality in hypertension

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Title: 182 Tissue doppler E’ velocity and E/e’ predict 19-year cardiovascular mortality in hypertension
Authors: Ramakrishnan, A
Shah, A
Thom, S
Sharp, A
Francis, D
Stanton, A
Poulter, N
Sever, P
Hughes, A
Mayet, J
Item Type: Conference Paper
Abstract: Background We have previously shown that tissue Doppler assessments of left ventricular (LV) diastolic function predict cardiac events in a hypertensive population over a period of 4 years. These out-performed traditional echocardiographic measures in a well-treated hypertensive population. Purpose We aimed to test whether tissue Doppler assessment of LV diastolic function would predict cardiovascular (CV) mortality in the Hypertension Associated Cardiovascular Disease sub-study of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Methods ASCOT was a multicentre randomised trial with a 2x2 factorial design. Inclusion criteria for the study included hypertension and three other CV risk factors, including male sex and age over 55. Protocols, including for echocardiography, have been detailed previously.This study comprised the 519 patients recruited to the St Mary’s Hospital site of the ASCOT study, who were followed for a median of 19 years with mortality flagged by the Office for National Statistics. We have used all reported deaths on or before 31st January 2019. CV deaths include deaths due to coronary heart disease (CHD), stroke and other CV causes. Echocardiography was performed one year after blood pressure control. mean tissue Doppler E’ was calculated as the average of septal, lateral and inferior wall measurements over three cycles. The ratio of the transmitral Doppler E wave velocity and the composite mean of E’ was used to calculate E/E’ ratio. Statistical analysis was performed using Python including multivariable Cox proportional hazards regression. A two-sided P-value <0.05 was considered statistically significant. Results After a median of 19 years (±5 years), 317 patients survived (mean age at baseline 60y, 38 female) and 202 did not (mean age 68y, 30 female). Twenty-three deaths were due to CHD, 11 were due to stroke, 27 were due to other CV causes, and 76 were due to cancer. Baseline characteristics were not significantly different between those who survived to follow up and those who did not. Unadjusted analysis showed a strong association between CV mortality and E’ (HR = 0.74, p <0.005) and E/E’ (HR = 1.18, p<0.005) (table 1). The association between CV mortality and E’ was attenuated slightly but persisted after adjusting for age and sex (HR = 0.83, p = 0.02) and after adjusting for age, sex and systolic BP (HR = 0.83, p = 0.03). The association between CV mortality and E/E’ was attenuated but persisted after adjusting for age and sex (HR = 1.12, p = 0.01) and after adjusting for age, sex and systolic BP (HR = 1.11, p = 0.04). There was a weak association between all-cause mortality and both E/E’ and E’, which was null after adjusting for age and sex. Figure 1 shows unadjusted Kaplan Meier survival curves for E’.
Issue Date: 1-Jun-2021
Date of Acceptance: 1-Jun-2021
URI: http://hdl.handle.net/10044/1/93893
DOI: 10.1136/heartjnl-2021-BCS.179
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: A140
End Page: A142
Journal / Book Title: Heart
Volume: 107
Copyright Statement: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Conference Name: British Cardiovascular Society Virtual Annual Conference, ‘Cardiology and the Environment’
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Science & Technology
Life Sciences & Biomedicine
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Publication Status: Published
Start Date: 2021-06-07
Finish Date: 2021-06-10
Conference Place: Online
Online Publication Date: 2021-06-04
Appears in Collections:National Heart and Lung Institute
School of Public Health