Study On The Relationship Between Left Ventricular Hypertrophy And Ischemic Stroke In Elderly Isolated Systolic Hypertension Patients

Objective:Investigating the effect of left ventricular hypertrophy (LVH) on ischemic stroke in elderly patients with isolated systolic hypertension (ISH), to provide basis for clinical diagnosis and treatment.Methods:A totle of 147 elderly isolated systolic hypertension (ISH)patients were selected from October 2014 to February 2016 in Cardiology Dept.3 (Special Medical Treatment Dept.1) of the second Affiliated Hospital of Kunming Medical University. The diagnostic criteria of ISH were judged according to the 24 hour ambulatory blood pressure. Collecting gender, age, smoking, body mass index (BMI) and other general information respectively, recording the results of CT,24h ambulatory blood pressure parameters, echocardiography, blood lipid, uric acid (UA) and other laboratory indexes. The left ventricular mass index (LVMI) was calculated according to the results of echocardiography, LVMI was used as the index of left ventricular hypertrophy (LVH, male>115g/m2, female>95g/m2), dividing the selected patients into left ventricular hypertrophy group (n=61,19 male,42 female, mean age 75.59±7.76 years old), and non hypertrophy group (n=86,38 male,48 female, mean age 73.8±8.8 years old), to analyze the relationship between LVH and ischemic stroke.Results:(1) The incidence of ischemic stroke in the left ventricular hypertrophy group was higher than that in the non hypertrophy group (p=0.042); after excluding diabetes which is a risk factor for stroke, patients with left ventricular hypertrophy had more significant effects on ischemic stroke(p=0.000).(2) Logistic regression analysis revealed that:age, duration of hypertension, diabetes were the risk factors of ischemic stroke (p<0.05); the people who had a higher age, having the higher risk of stroke (OR=1.070,95%CI:1.017-1.125,p=0.009); who had the longer duration of hypertension, having the higher risk of stroke (OR=1.047,95%CI:1.006-1.089,p=0.023); the risk of stroke in hypertensive patients with diabetes was 2.3 times higher than that of non diabetics (OR=2.333, 95%CI:1.041-5.226, p=0.040).(3) ROC curve analysis showed that:left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular mass (LVM), left ventricular mass index (LVMI) and ventricular relative wall thickness (RWT), the five indexes which can reflect LVH had no statistical significance in predicting value for ischemic stroke (p>0.05). IVST, LVPWT, LVM, LVMI had certain predictive value for ischemic stroke, but the accuracy were low(0.5<AUC<0.7); relatively speaking, LVMI had the highest predictive value for ischemic stroke (AUC=0.586).(4) The average systolic blood pressure level of non hypertrophy group was (129.21±9.68)mmHg, the mean systolic blood pressure in the left ventricular hypertrophy group was (132.59±9.59)mmHg, the difference between the two groups has statistical significance (p=0.038)(5) Pearson linear correlation analysis revealed that:LVMI was positively correlated with mean systolic blood pressure at night (r=0.164,p=0.047).Conclusions:1、In elderly ISH patients, the occurrence of ischemic stroke is associated with LVH, after excluding diabetes which is a risk factor for stroke, patients with left ventricular hypertrophy had more significant effects on ischemic stroke, LVH is an important predictor of ischemic stroke;2、In elderly patients with ISH, the incidence of LVH is positively correlated with the mean systolic blood pressure at night:3、Age, duration of hypertension and diabetes are important risk factors for ISH patients who have ischemic stroke, which have predictive value for the occurrence of ischemic stroke in elderly ISH patients.