Change of Body Surface Electrocardiogram is Linked to Left Ventricular Geometric Alteration from Normal, Pre-Hypertension to Hypertension: Comparison of NT-ProBNP and hs-CRP in Determining Ventricular Remodeling

Chih-Hsuan Yen ； Jui-Peng Tsai ； Yih-Jer Wu ； Jen-Yuan Kuo ； Hung-I Yeh ； Charles Jia-Yin Hou ； Chuan-Chuan Liu ； Chung-Lieh Hung

《Acta Cardiologica Sinica》 27期1期 (2011/03) Pp. 29-37

並列摘要

Background: The presence of echocardiographic left ventricular remodeling and hypertrophy, a potential surrogate of pathophysiology intermediate between hypertension and heart failure, has been strongly linked to increased cardiovascular events. Electrocardiography (ECG) data regarding such a continuous change in pre-hypertension and hypertension subjects and their comparison with hiomarkers are still elusive.
Methods and Materials: We studied 364 subjects including 140 normal subjects (mean age 47.6±9.4, 49% female), 136 pre-hypertensives (mean age 50.6±9.6, 32% female) and 88 hypertensives (mean age 58.6±11.5, 44% female). Baseline demographic data and levels of biomarkers [high-sensitivity C-reactive protein (hs-CRP) and N-terminal-pro-B type natriuretic peptide (NT-ProBNP)] were collected, with various 12-lead surface ECG criteria analyzed. Echo-derived left ventricular (LV) geometries were assessed through standardized methods. We used nonparametric trend tests for comparing continuous variables across different groups with receiver-operating characteristic (ROC) curves constructed from both ECG and biomarkers for identifying echo-defined ventricular remodeling and hypertrophy.
Results: Of all 364 subjects under survey, several ECG-based parameters demonstrated continuous changes in an ordered fashion across different groups (all p＜0.05) which paralleled those observed from biomarkers and echo-derived LV geometric changes and function. NT-ProBNP alone identified echo-derived LV hypertrophy (LVH) better than hs-CRP (AUC: 0.72 vs. 0.62, respectively, both p＜0.05) while neither showed satisfactory result in identifying concentric remodeling. The ROC area under curve in identifying LVH showed comparative result between some electrocardiography (ECG) parameters and NT-ProBNP, with Cornell product revealed to have the highest predictive value (AUC: 0.73, p＜0.05).
Conclusion: Surface ECG yielded ability comparable to that of NT-ProBNP in identifying LVH. LV geometric remodeling, when defined by surface ECG, seemed to progress in subjects from normal, pre-hypertension to hypertension. This evidence suggests that aggressive control of blood pressure may he helpful at an earlier stage.

並列關鍵字

Echocardiography ； Electrocardiography ； hs-CRP ； Hypertension ； Left ventricular hypertrophy ； NT-ProBNP