Assessment of Target Organ Damage: Established and Novel Methods Christian Delles BHF Glasgow...
-
Upload
jacob-sherman -
Category
Documents
-
view
218 -
download
1
Transcript of Assessment of Target Organ Damage: Established and Novel Methods Christian Delles BHF Glasgow...
Assessment of Target Organ Damage:Established and Novel Methods
Christian Delles
BHF Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow
Joint British Societies
Cardiovascular Risk
2013 ESH/ESC Guidelines. J Hypertens 2013
Organ Damage and Cardiovascular Risk
Dzau V et al. Circulation 2006
The Cardiovascular Continuum
ESH Taskforce Document. J Hypertens 2009
Subclinical Organ Damage and CV Risk
Study
TsioufisMihaniCASE-J trialCV Health StudyELSALaurentFowkesDe BuyzereKorenTsioufisHOTINSIGHTJensen
Condition
HypertensionOutpatientsHypertensionElderlyHypertensionHypertensionOutpatientsOutpatientsHypertensionHypertensionHypertensionHypertensionHypertension
10 yr CVD ≥ 20%
YesYesYesYesYesYes
Yes (men)Yes (men)
YesYesYesYes
Yes (CHD)
Organ damage
LVH (echo)LVH (echo)LVH (echo) Ca IMT (highest quintile) Ca IMT (2 highest quintiles)PWV (highest quintile) Ankle / brachial ratio Ankle / brachial ratioLVH (echo)Low eGFRLow eGFR or high SCR (≥ 1.5 mg/dl)Low eGFR or high SCR (≥ 1.5 mg/dl)MA
Heart
Schmieder RE. Dtsch Arztebl Int 2010
ECG: Indices of Left Ventricular Hypertrophy
Sokolow-Lyon Index:
SV1 + RV5/6
≥ 3.8 mV (3.5 mV)
Cornell Voltage Product:
Men:(RaVL + SV3) × QRS> 244 mV msec
Women:(RaVL + SV3 +0.8) × QRS> 244 mV msec
e-cardiogram.com
ECG: Sokolow-Lyon Index
ECG Voltage Criteria and CV Events
Levy D at al. Circulation 1994
Echocardiography
Echocardiography
2013 ESH/ESC Guidelines. J Hypertens 2013
Left Ventricular Mass and CV Events
Schillaci G et al. Hypertension 2000
The ECG is valuable [for detection of LVH], at least in patients over 55
years of age. Electrocardiography can also be used to detect patterns of
ventricular overload or ‘strain’, which indicates more severe risk,
ischaemia, conduction abnormalities, left atrial dilatation and arrhythmias,
including atrial fibrillation.
2013 ESH/ESC Guidelines. J Hypertens 2013
Cardiac Damage
Echocardiography should be considered in hypertensive patients in
different clinical contexts and with different purposes:
• in hypertensive patients at moderate total CV risk, it may refine the risk
evaluation by detecting LVH undetected by ECG
• in hypertensive patients with ECG evidence of LVH it may more
precisely assess the hypertrophy quantitatively and define its geometry
and risk
• in hypertensive patients with cardiac symptoms, it may help to diagnose
underlying disease.
2013 ESH/ESC Guidelines. J Hypertens 2013
Cardiac Damage
Blood Vessels
Dzau V et al. Circulation 2006
The Cardiovascular Continuum
Endothelial Function: Flow-mediated Dilatation
Vascular Stiffness and CV Events
Willum-Hansen T et al. Circulation 2006
Blood Pressure Determines CV Risk
Prospective Studies Collaboration. Lancet 2002
Pulse Pressure Refines CV Risk
Franklin SS et al. Circulation 1999
Atherosclerosis and Vascular Stiffness
Ng et al. Am J Physiol Renal Physiol 2011Wikipedia.org
Vascular Stiffness: Pulse Wave Velocity
Vascular Stiffness and Mortality
Relative Risk of Cardiovascular Mortality According to PWV and Cardiovascular Risk Factors: Univariate Analysis
Parameters OR Lower 95% CI Higher 95% CI P
PWV, 5 m/s 2.35 1.76 3.14 <0.0001
Previous CVD, yes/no 14.81 7.98 27.47 <0.0001
Age, 10 y 2.32 1.78 3.01 <0.0001
PP, 10 mm Hg 1.53 1.31 1.80 <0.0001
SBP, 10 mm Hg 1.26 1.12 1.42 <0.001
Diabetes, yes/no 4.23 1.96 9.15 <0.001
Laurent S et al. Hypertension 2001
Carotid Intima-Media Thickness
Barth JD. Am J Cardiol 2002
Healthy subject Patient with arterial hypertension and hypercholesterolaemia