Vol 70, No 3 (2012)
Original articles
Published online: 2012-03-19
The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension
DOI: 10.33963/v.kp.78985
Kardiol Pol 2012;70(3):223-231.
Abstract
Background: Interest in the role of arterial stiffness in the pathomechanism of left ventricular (LV) diastolic dysfunction has
grown in recent years.
Aim: To examine the relationship between local carotid arterial stiffness parameters assessed by the ultrasonic high-resolution echo-tracking (eT) method and LV diastolic function indices in patients with untreated hypertension (H).
Methods: The study group consisted of 173 subjects, 78 male and 95 female, 113 of them with untreated H, mean age 55.7 ± 10.4 years, and 60 age-matched controls. Using 2D echo, conventional and tissue Doppler echocardiography, LV systolic and diastolic function and left ventricular hypertrophy (LVH) indices were assessed. Hypertensives were divided into two groups: those with diastolic dysfunction (HDD+: with relaxation abnormalities, n = 55 and with pseudonormalisation pattern, n = 12); and those without diastolic dysfunction (HDD–, n = 46). Using carotid arteries ultrasound, intima media thickness (IMT) and eT arterial stiffness parameters were evaluated, as also were β — beta, Ep — epsilon, AC — arterial compliance, PWVβ — one-point pulse wave velocity and AI — augmentation index.
Results: Linear regression analysis revealed significant correlations between arterial stiffness indices and diastolic function parameters in the study groups: the ratio of early to late transmitral pulse Doppler velocities — E/A — correlated to Ep,β, AC and PWVβ (r = –0.30, r = –0.25, r = 0.26, r = –0.30, respectively, p < 0.05); early diastolic mitral annular velocity — e′ — correlated to Ep, β and PWVβ (r = –0.22, r = –0.26, r = –0.25, respectively, p < 0.05); the ratio of early to late diastolic mitral annular velocities — e′/a′ — was correlated with β and PWVβ (r = –0.28, r = –0.28, respectively, p < 0.05). HDD+ did not present echocardiographic LVH. Using ROC curve analysis, we identified optimal cut-off values of different parameters in the determination of diastolic dysfunction occurrence. Univariable analysis revealed the following significant variables in determining LV diastolic dysfunction: β > 9.2 (OR 2.65, p = 0.026), Ep > 118 kPa (OR 3.53, p = 0.040), PWVβ > 6.2 m/s (OR 3.92, p = 0.002), AI > 7.8 (OR 2.62, p = 0.049), age > 54 (OR 4.76, p < 0.001), diabetes presence (OR 2.78, p = 0.013), IMT > 0.51 mm (OR 4.49, p < 0.001), diastolic blood pressure < 70 mm Hg (OR 3.38, p = 0.047), pulse pressure > 64 (OR 2,90, p = 0.031) and ejection fraction < 76 (OR 3.38, p = 0.019). However, at multivariate analysis, only age (OR = 2.43, p = 0.073), IMT (OR = 4.56, p = 0.002) and PWVβ (OR = 2.18; p = 0.091) were independently associated with diastolic dysfunction occurrence.
Conclusions: Carotid IMT as a marker of subclinical atherosclerosis and PWVβ as an index of carotid arterial stiffness are, besides age, independently associated with LV early diastolic dysfunction occurrence in untreated middle-aged hypertensives.
Aim: To examine the relationship between local carotid arterial stiffness parameters assessed by the ultrasonic high-resolution echo-tracking (eT) method and LV diastolic function indices in patients with untreated hypertension (H).
Methods: The study group consisted of 173 subjects, 78 male and 95 female, 113 of them with untreated H, mean age 55.7 ± 10.4 years, and 60 age-matched controls. Using 2D echo, conventional and tissue Doppler echocardiography, LV systolic and diastolic function and left ventricular hypertrophy (LVH) indices were assessed. Hypertensives were divided into two groups: those with diastolic dysfunction (HDD+: with relaxation abnormalities, n = 55 and with pseudonormalisation pattern, n = 12); and those without diastolic dysfunction (HDD–, n = 46). Using carotid arteries ultrasound, intima media thickness (IMT) and eT arterial stiffness parameters were evaluated, as also were β — beta, Ep — epsilon, AC — arterial compliance, PWVβ — one-point pulse wave velocity and AI — augmentation index.
Results: Linear regression analysis revealed significant correlations between arterial stiffness indices and diastolic function parameters in the study groups: the ratio of early to late transmitral pulse Doppler velocities — E/A — correlated to Ep,β, AC and PWVβ (r = –0.30, r = –0.25, r = 0.26, r = –0.30, respectively, p < 0.05); early diastolic mitral annular velocity — e′ — correlated to Ep, β and PWVβ (r = –0.22, r = –0.26, r = –0.25, respectively, p < 0.05); the ratio of early to late diastolic mitral annular velocities — e′/a′ — was correlated with β and PWVβ (r = –0.28, r = –0.28, respectively, p < 0.05). HDD+ did not present echocardiographic LVH. Using ROC curve analysis, we identified optimal cut-off values of different parameters in the determination of diastolic dysfunction occurrence. Univariable analysis revealed the following significant variables in determining LV diastolic dysfunction: β > 9.2 (OR 2.65, p = 0.026), Ep > 118 kPa (OR 3.53, p = 0.040), PWVβ > 6.2 m/s (OR 3.92, p = 0.002), AI > 7.8 (OR 2.62, p = 0.049), age > 54 (OR 4.76, p < 0.001), diabetes presence (OR 2.78, p = 0.013), IMT > 0.51 mm (OR 4.49, p < 0.001), diastolic blood pressure < 70 mm Hg (OR 3.38, p = 0.047), pulse pressure > 64 (OR 2,90, p = 0.031) and ejection fraction < 76 (OR 3.38, p = 0.019). However, at multivariate analysis, only age (OR = 2.43, p = 0.073), IMT (OR = 4.56, p = 0.002) and PWVβ (OR = 2.18; p = 0.091) were independently associated with diastolic dysfunction occurrence.
Conclusions: Carotid IMT as a marker of subclinical atherosclerosis and PWVβ as an index of carotid arterial stiffness are, besides age, independently associated with LV early diastolic dysfunction occurrence in untreated middle-aged hypertensives.
Keywords: arterial stiffnessdiastolic dysfunctionhypertension
