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Structure and function features and adverse prognostic factors of compensated hypertensive heart disease

Ovchinnikov A. G., Ozhereljeva M. V., Masenko V. P., Ageev F. T.
Federal State Budgetary Institution, "Russian Cardiology Science and Production Center" of the Ministry of Health of the Russian Federation, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: arterial hypertension, left ventricle hypertrophy, diastolic dysfunction of the left ventricle, systolic dysfunction of the left ventricle, heart failure with preserved ejection fraction

DOI: 10.18087/rhj.2017.3.2347

Background. Hypertensive heart disease is the major cause of heart failure with preserved ejection fraction (HF‑PEF). However, neither the incidence nor determinants of transition from asymptomatic LV hypertrophy (LVH) to HF‑PEF have been established so far. It is also unclear how often LV systolic dysfunction (SD) develops in these patients, and what mechanism underlies it. Aim. To evaluate structure and function features of the HF‑PEF course in patients with compensated hypertensive heart disease. Materials and methods. Based on archived documents, a cohort of 350 “sequential” patients was selected; these patients had been diagnosed with asymptomatic, concentric, hypertensive LVH and normal LV EF at their visit to the Science and Medicine Department of the A.L. Myasnikov Institute of Clinical Cardiology between 2002 and 2010. 223 patients returned for a revisit. Results. Median time between the first visit and the revisit was 8.1 years. During that time, 161 (72%) patients developed HF‑PEF whereas only 34 (15%) patients developed LV SD, including 18 (8%) cases caused by previous MI (“external” mechanism) and 16 (7%) cases resulting from long‑term pressure overload (“internal” mechanism). In the latter case, LV SD was slight and not associated with transition to eccentric LVH. Independent predictors of HF‑PEF included elderly age, LVH progression, and absence of the statin treatment; predictors of LV SD mediated by the “internal” mechanism included permanent atrial fibrillation and a high body mass index. Conclusion. Hypertensive heart disease very often results in HF‑PEF due to LV DD progression and the absence of statin treatment. In contrast, LV SD induced by long‑term pressure overload is an uncommon complication of hypertensive heart disease.
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Ovchinnikov A. G., Ozhereljeva M. V., Masenko V. P., Ageev F. T. Structure and function features and adverse prognostic factors of compensated hypertensive heart disease. Russian Heart Journal. 2017;16 (3):185–196

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