Pulmonary venous flow and risk of cardiovascular disease in essential hypertension

OBJECTIVE: The prognostic significance of the pulmonary venous flow in essential hypertensive patients was investigated. METHODS AND RESULTS: Doppler transthoracic echocardiograms were analyzed in 705 essential hypertensive subjects with no prior cardiovascular disease. At baseline, most subjects had 'normal diastolic function' or 'mild diastolic dysfunction'. During follow-up (mean, 32 months), 56 participants developed cardiovascular disease. Sex-specific median values were used to separate the higher group from the lower group of the peak velocity ratio of the pulmonary venous systolic to diastolic wave (S/D) (male < 1.51, female < 1.66), and of the transmitral velocity ratio of early diastolic to atrial filling (E/A) (male < 0.84, female < 0.82). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the groups with high S/D (P < 0.01) and low E/A (P < 0.01), respectively. In multivariate Cox regression analysis, the S/D ratio (HR 1.07 for each 0.1 increase, P = 0.03) or E/A ratio (P < 0.01) was an independent predictor of cardiovascular disease events. When divided into four groups based on the respective sex-specific median levels of S/D in the E/A ≥ median and E/A < median groups, the group with high S/D and low E/A (S/D; male ≥ 1.77, female ≥ 1.81) had a significantly poorer event-free survival rate (χ = 28.06, P < 0.01), and the adjusted-hazard ratio by multivariate Cox regression analysis was 2.16 (95% CI; 1.40-3.07, P < 0.01). CONCLUSION: Increased S/D or decreased E/A is associated with an increased cardiovascular disease risk, and the combination of high S/D and low E/A may be a powerful predictor of cardiovascular disease in essential hypertension. Pulmonary venous flow evaluation may provide clinically important prognostic information in patients with essential hypertension.