Assessment of Target Organ Damage:
Established and Novel Methods
Christian Delles
BHF Glasgow Cardiovascular Research Centre
Institute of Cardiovascular and Medical Sciences
University of Glasgow
Cardiovascular Risk
Joint British Societies
Organ Damage and Cardiovascular Risk
2013 ESH/ESC Guidelines. J Hypertens 2013
The Cardiovascular Continuum
Dzau V et al. Circulation 2006
Subclinical Organ Damage and CV Risk
Study
Condition
Organ damage
10 yr CVD ≥ 20%
Tsioufis
Mihani
CASE-J trial
CV Health Study
ELSA
Laurent
Fowkes
De Buyzere
Koren
Tsioufis
HOT
INSIGHT
Jensen
Hypertension
Outpatients
Hypertension
Elderly
Hypertension
Hypertension
Outpatients
Outpatients
Hypertension
Hypertension
Hypertension
Hypertension
Hypertension
LVH (echo)
LVH (echo)
LVH (echo)
 Ca IMT (highest quintile)
 Ca IMT (2 highest quintiles)
PWV (highest quintile)
 Ankle / brachial ratio
 Ankle / brachial ratio
LVH (echo)
Low eGFR
Low eGFR or high SCR (≥ 1.5 mg/dl)
Low eGFR or high SCR (≥ 1.5 mg/dl)
MA
Yes
Yes
Yes
Yes
Yes
Yes
Yes (men)
Yes (men)
Yes
Yes
Yes
Yes
Yes (CHD)
ESH Taskforce Document. J Hypertens 2009
Heart
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
Schmieder RE. Dtsch Arztebl Int 2010
ECG: Sokolow-Lyon Index
e-cardiogram.com
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
Cardiac Damage
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
Blood Vessels
The Cardiovascular Continuum
Dzau V et al. Circulation 2006
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
Wikipedia.org
Ng et al. Am J Physiol Renal Physiol 2011
Vascular Stiffness: Pulse Wave Velocity
Vascular Stiffness and Mortality
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
Relative Risk of Cardiovascular Mortality According to PWV and Cardiovascular
Risk Factors: Univariate Analysis
Laurent S et al. Hypertension 2001
Carotid Intima-Media Thickness
Healthy subject
Patient with arterial hypertension and
hypercholesterolaemia
Barth JD. Am J Cardiol 2002