Usefulness of Stress-Derived E/e’ Ratio in Asymptomatic Hypertensive Patients

Abstract

<b><i>Purpose:</i></b> We sought to investigate the usefulness of stress echocardiography-derived E/e’ in predicting subclinical atherosclerosis in asymptomatic hypertensive patients. <b><i>Materials and Methods:</i></b> 71 newly diagnosed untreated hypertensive patients (48 ± 13 years, 65% males) and 30 age- and sex-matched healthy controls were recruited. Resting and exercise echocardiography was performed to assess resting diastolic blood pressure and the diastolic stress parameters. Coronary flow reserve (CFR) was evaluated as well. <b><i>Results:</i></b> Based on CFR values, newly diagnosed, untreated hypertensives were stratified into hypertensives with microvascular dysfunction (MVD; 34 patients had CFR &#x3c;2.0) and those without MVD (37 patients had CFR ≥2.0). Patients with MVD had a significantly higher C-reactive protein level (<i>p</i> &#x3c; 0.05) and lower metabolic equivalent values (<i>p</i> &#x3c; 0.05). With resting echocardiography, only the left atrial volume index (LAVI) was significantly increased in those with MVD compared with those without MVD and controls (<i>p</i> &#x3c; 0.05). With exercise echo, the E/e’ was significantly increased in MVD patients compared with those without MVD and controls (<i>p</i> &#x3c; 0.001). Importantly, the percentage of subjects with exercise E/e’ ≥15 was 76.5% (26 patients in the group with MVD), 4.1% (3 patients in the group without MVD), and 0% in controls. At univariate analysis, high-sensitivity C-reactive protein (<i>p</i> &#x3c; 0.05), LAVI (<i>p</i> &#x3c; 0.05), and exercise E/e’ (<i>p</i> &#x3c; 0.001) were independently associated with reduced CFR. On the other hand, at multivariate analysis, only exercise E/e’ was the independent predictor of reduced CFR in newly diagnosed hypertensives. <b><i>Conclusion:</i></b> We have demonstrated significant associations between exercise-derived raised left ventricular pressure and coronary MVD in newly diagnosed untreated hypertensive patients. Herein, we supposed that exercise-derived E/e’ could predict subclinical atherosclerosis and might be a risk parameter for newly diagnosed untreated hypertensive patients.