The elevation of left ventricular filling pressure (LVFP) could be an important prognostic factor in patients with hypertension.

We hypothesized that noninvasive brachial-ankle pulse wave velocity (baPWV) is associated with increased LVFP in hypertensive patients with LV hypertrophy (LVH).

We enrolled patients with well-controlled hypertension for more than 1 year with LV ejection fraction (LVEF) ≥55%, and LVH.

The relationship between Doppler echocardiographic parameters of LVFP and baPWV with B-type natriuretic peptide (BNP) was also evaluated.

Results 

A total of 62 patients were enrolled (31 patients with E/E_a >15 and 31 patients with E/E_a ≤15) and the baPWV of the E/E_a >15 group was significantly increased compared to the E/E_a ≤15 group (1,664.3 ± 270.5 vs. 1,381.9 ± 159.1 cm/s, P < 0.01).

The baPWV showed better correlation with E/E_a (r = 0.69, P < 0.01) than the BNP (r = 0.47, P < 0.01).

A multivariate linear regression model showed that only baPWV was significantly correlated with E/E_a, and that the association was independent of other factors.

In this study, we have demonstrated that elevated baPWV is associated with noninvasive markers of increased LVFP in hypertensive LVH patients with preserved LV systolic function. 

Left ventricular hypertrophy (LVH) is a common finding in patients with hypertension.

There is strong evidence that LVH plays an important role in the development of heart failure and is associated with a higher mortality rate in the hypertensive patients.¹

In addition, the parameters of elevated LV filling pressure (LVFP) are strongly related to LVH.²

Many studies with echocardiography have shown that the ratio of early transmitral E wave velocity to early diastolic mitral annular E_a wave velocity (E/E_a) correlates well with invasive measurement of LVFP³ and correlates better with pulmonary capillary wedge pressure than brain natriuretic peptide in patients with cardiac disease.⁴

In general, the measurement of an E/E_a >15 is a reliable marker of increased LVFP.⁵

The pulse wave velocity (PWV) reflects arterial stiffness, and it could be a marker of both the severity of vascular damage and the prognosis of cardiovascular diseases in patients with hypertension or abnormal glucose metabolism.^6,7

Now, baPWV has become a useful screening method for cardiovascular disease and as a test to assess the severity of atherosclerotic vascular damage in the general population.⁸

However, it is not clear whether baPWV could be used to predict LVFP in the hypertensive patients with LVH.

We hypothesized that baPWV could be a noninvasive method for detecting increased LVFP in hypertensive LVH patients with preserved LV systolic function.

We also evaluated for the relationship between Doppler echocardiographic parameters of LVFP and baPWV with B-type natriuretic peptide (BNP).

SEE FULLTEXT

http://www.nature.com/ajh/journal/v23/n3/full/ajh2009243a.htmAmerican

Journal of Hypertension 2010; doi:10.1038/ajh.2009.243

Kyoung-Ha Park¹, Woo Jung Park¹, Min-Kyu Kim¹, Jae-Hun Jung¹, Seonghoon Choi¹, Jung Rae Cho¹, Hyun-Sook Kim¹, Namho Lee¹ and Goo-Yeong Cho²

1. ¹Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea
2. ²Cardiovascular Division, Department of Internal Medicine, Seoul National University Hospital, Bundang, Korea

Correspondence: Kyoung-Ha Park, pkhmd@naver.com