Relation of Inappropriate Left Ventricular Hypertrophy on Framingham Risk Score and Vascular Stiffness in Hypertensive Women

Hyue Mee Kim; Ji-Hyun Jung; Hak Seung Lee; Chee Hae Kim; Goo-Yeong Cho

doi:10.5646/jksh.2013.19.3.81

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Kim, Jung, Lee, Kim, and Cho: Relation of Inappropriate Left Ventricular Hypertrophy on Framingham Risk Score and Vascular Stiffness in Hypertensive Women

Original Article

J Korean Soc Hypertens 2013;19(3):81-89.

Published online: 10 September 2013

DOI: https://doi.org/10.5646/jksh.2013.19.3.81

Relation of Inappropriate Left Ventricular Hypertrophy on Framingham Risk Score and Vascular Stiffness in Hypertensive Women

Hyue Mee Kim, MD¹, Ji-Hyun Jung, MD¹, Hak Seung Lee, MD¹, Chee Hae Kim, MD¹, Goo-Yeong Cho, MD^2,

¹Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

²Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Tel: 031) 787-7024 Fax: 031) 787-4051 E-mail: cardioch@snu.ac.kr

Received 31 May 201325 September 2013 Accepted 26 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

Although left ventricular hypertrophy (LVH) is a compensatory process to pressure overload, there are gender differences in left ventricular function and vascular stiffness in hypertension. We evaluated that inappropriate LVH was related with Framingham risk score (FRS) and vascular stiffness in hypertensive women.

Methods:

Total 226 hypertensive women consecutively underwent carotid ultrasound and echocardiography, from which LV mass (LVM), carotid intima-media thickness (IMT) and -stiffness were measured. Inappropriate LVH was calculated by the ratio of observed LVM to the β value predicted for sex, height and stroke work at rest and defined as > 128% of predicted. FRS was obtained using by National Cholesterol Education Program Adult Treatment Panel III.

Results:

Of 226 subjects, 59 subjects (26%) had inappropriate LVH. As compared with appropriate LVH, subject with inappropriate LVH showed older age, higher FRS, and IMT. Although LV ejection fraction was not different, diastolic parameters of E/A ratio and left atrial volume were significantly worse in inappropriate LVH group.

Conclusions:

The presence of inappropriate LVH in hypertensive women was strongly associated with higher FRS, decreased diastolic function and increased IMT, which might influence future cardiovascular events.

Keywords: Left ventricular hypertrophy, Vascular stiffness, Hypertension, Women

References

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Fig. 1.

Measurement of carotid intima-media thickness (IMT).

Fig. 2.

Measurement of luminal strain.

Fig. 3.

Correlation between left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) and b-stiffness.

Fig. 4.

Correlation between left ventricular mass (LVM) and Framingham risk score (FRS). LVMI, left ventricular mass index.

Table 1.

Baseline clinical characteristics

Subject	Appropriate (n = 167)	Inappropriate (n = 59)
Age (yr)	60.9 ± 12.5	70.5 ± 8.1^*
Body mass index (kg/m²)	24.2 ± 3.2	26.8 ± 3.5^*
Baseline risk factors
Diabetes	38 (22.8)	11 (18.6)
Dyslipidemia	82 (49.1)	24 (40.7)
Current smoking	13 (7.8)	7 (11.9)
Fasting glucose (mg/dL)	118 ± 41	114 ± 30
Creatinine (mg/dL)	0.8 ± 0.3	1.0 ± 1.0
Total cholesterol	196 ± 46	188 ± 37
Low density lipoprotein cholesterol	111 ± 41	106 ± 31
High density lipoprotein cholesterol	54 ± 17	53 ± 13
Systolic blood pressure (mm Hg)	132 ± 19	140 ± 23^*
Diastolic blood pressure (mm Hg)	76 ± 12	78 ± 12
Mean blood pressure (mm Hg)	95 ± 13	99 ± 14^*
Framingham risk score (%)	4.4 ± 4.2	9.9 ± 7.2^*

Values are presented as mean ± standard deviation or number (%).

^* p-value < 0.05.

Table 2.

Baseline echocardiographic parameters

Subject	Appropriate (n = 167)	Inappropriate (n = 59)
Observed LVMI (g/m^2.7)	39.9 ± 7.2	63.3 ± 10.4^*
LVMI (g/m²)	83.3 ± 14.9	121.9 ± 18.9^*
Systolic function
Left ventricular ejection fraction (%)	61.5 ± 4.7	60.1 ± 7.0
Stroke volume (mL)	66.2 ± 16.2	72.7 ± 16.3
s’ (cm/sec)	6.7 ± 1.5	6.0 ± 1.3^*
Diastolic function
E/A ratio	0.97 ± 0.35	0.78 ± 0.22^*
Deceleration time (msec)	225 ± 49	242 ± 49^*
e’ (cm/sec)	6.7 ± 2.1	4.9 ± 1.2^*
Left atrial volume index (mL/m²)	25.7 ± 6.3	35.7 ± 27.7^*
Carotid parameters
Intima-media thickness (mm)	0.71 ± 0.16	0.79 ± 0.14^*
Strain (%)	6.5 ± 2.5	5.8 ± 2.1
β -stiffness	0.10 ± 0.05	0.11 ± 0.06

Values are presented as mean ± standard deviation.

Observed LVMI, observed left ventricular mass index; s’, mitral annulus systolic velocity; E/A ratio, the ratio of the early (E) to late (A) ventricular filling velocities; e’, early diastolic velocity.

^* p-value < 0.05.

Table 3.

Cardiovascular performance

Subject	Appropriate (n = 167)	Inappropriate (n = 59)
Arterial elastance (Ea, mmHg/mL)	1.89 ± 0.52	1.80 ± 0.44
Ventricular elastance (Ees, mmHg/mL)	3.07 ± 1.01	2.80 ± 0.87
Vascular-ventricular coupling index	0.64 ± 0.14	0.70 ± 0.3^*

Values are presented as mean ± standard deviation.

^* p-value < 0.05.

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