Association between Coronary Artery Disease and Left Ventricle Remodeling Parameters in Hypertensive Patients: A Cross-Sectional Study in a Limited Resource Setting

Abstract

BACKGROUND: Coronary artery disease (CAD) and hypertension are related with left ventricle (LV) remodeling, however evidence about association between CAD and remodeling in hypertensive patient is still limited, especially in limited resource setting like Indonesia. AIM: Evaluating impact of CAD on LV remodeling within hypertensive patients at tertiary referral hospital, Hasan Sadikin General Hospital Bandung, Indonesia. METHOD: Cross-sectional study involving 120 hypertensive patients who visited cardiology outpatient clinic from September-December 2019 and underwent transthoracic echocardiography examination for any medical indications. LV remodeling parameters, such as mass (LV Mass Index [LVMi]), volume (end-diastolic volume/body surface area [BSA]), and relative wall thickness (RWT), were compared between CAD and non-CAD groups. RESULTS: There were 108 patients to be analyzed, 12 patients were excluded due to technical difficulty (n = 9) and non-cooperative during interview (n = 3). Mean (standard deviation) age of patients was 56.9 (±11.8) years, 50 (46.3%) patients were male, and median (interquartile range) hypertension duration was 3 (±4.40) years. CAD was found in 40 (37.0%) patients. In the adjusted analysis, patients with CAD had average 27.75 g/m2 higher LVMi (95% confined interval [CI] 2.03; 53.47; p = 0.035) and 16.20 ml/m2 higher LV end-diastolic volume/BSA (95% CI 4.14; 28.25; p = 0.009) compared to those without. This was independent of age, duration of hypertension, consumption of antihypertensive therapy, and type-2 diabetes mellitus, but disappeared after heart failure (HF) was included in the study. CAD and non-CAD groups were not different, respectively, to RWT. CONCLUSION: In hypertensive patients, CAD was independently associated with higher LV mass and volume. These associations, however, were largely explained by the presence of HF. CAD did not associate with RWT.