Hipertansif hastalarda presistolik A dalgası ile aort distensibilitesi arasındaki ilişki

Amaç: Arteriyel sertlik, hipertansif hastalarda kardiyovasküler ve tüm nedenlere bağlı mortalitenin bağımsız bir öngörücüsü olarak gösterilmiştir. Sol ventrikül çıkış yolunun nabız Doppler ekokardiyografik incelemesinde sıklıkla görülen presistolik A dalgası (PSW), diyastolik disfonksiyon ve arteriyel sertlik parametreleri ile ilişkilidir. Çalışmamız aort distensibilitesi (AD) ile PSW arasındaki ilişkiyi incelemeyi amaçlamaktadır. Gereç ve Yöntem: Polikliniğimize ayaktan başvuran hipertansif hastalar çalışmaya dahil edildi. Aort sertliği, ekokardiyografide aort çapları m-modu ile ölçülerek hesaplandı ve apikal beş boşluk görünümde sol ventrikül çıkış yolunda, aort kapağının hemen proksimalinden PSW olup olmadığı kaydedildi. Bulgular: Toplam 149 hipertansif hasta çalışmaya dahil edildi. PSW varlığında diyastolik kan basıncı, septum çapı, arka duvar çapı, aortik diyastolik ve sistolik çap anlamlı olarak yüksekti. Aort distensibilitesi (AD) PSW'li hastalarda daha. Çok değişkenli lojistik regresyon analizi, AD'nin (OR: 0,812, %95 GA: 0,712 – 0,927, p = 0,002) PSW varlığının bağımsız bir prediktörü olduğunu gösterdi. Sonuç: PSW varlığı, azalmış aort distensibilitesi ile değerlendirilen aort sertliği ile ilişkilidir ve hipertansiyon hastalarında aort sertliğinin bağımsız bir prediktörü olarak kullanılabilir.

Anahtar Kelimeler:

hipertansiyon, aort sertliği, aortik distansibilite, presistolik A dalgası

Relationship between presystolic A wave and aortic distensibility in hypertensive patients

Purpose: Arterial stiffness has been shown as an independent predictor of cardiovascular and all-cause mortality in hypertensive patients. commonly seen in pulse wave Doppler echocardiographic examination of the left ventricle outflow tract, is related to diastolic dysfunction and arterial stiffness parameters. Our study aims to investigate the relation between aortic distensibility (AD) and presystolic A wave (PSW),. Materials and Methods: Hypertensive patients were included in the study. Aortic stiffness was calculated by measuring aortic diameters with m-mode in echocardiography, and the presence of PSW was noted from the left ventricle outflow tract just proximal to the aortic valve in apical five-chamber view. Results: A total of 149 hypertensive patients were included. Diastolic blood pressure, septum diameter, posterior wall diameter, aortic diastolic, and systolic diameter were significantly higher in the presence of PSW. Aortic distensibility (AD) was higher in patients with PSW. Multivariable logistic regression analysis showed that AD (OR: 0.812, 95% CI: 0.712 – 0.927, p = 0.002) was an independent predictor of PSW presence. Conclusion: PSW presence is associated with aortic stiffness evaluated by decreased aortic distensibility and highlights that PSW presence could be an independent predictor of aortic stiffness in patients with HT.

Keywords:

hypertension, aortic stiffness, aortic distensibility, presystolic A wave,

PDF

___

1. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63:636-46.
2. Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113:664-70.
3. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113:657-63.
4. Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121:505-11.
5. Kelly RP, Tunin R, Kass DA. Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle. Circ Res. 1992;71:490-502.
6. Sahin AA, Ozben B, Sunbul M, Yagci I, Sayar N, Cincin A et al. The effect of cardiac rehabilitation on blood pressure, and on left atrial and ventricular functions in hypertensive patients. J Clin Ultrasound. 2020;10.1002/jcu.22956:e22956.
7. Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick TH. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart. 2005;91:1551-6.
8. Armstrong WF, Ryan T, Feigenbaum H. Feigenbaum's Echocardiography. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.
9. Mittal SR, Pancholi N. Left ventricular outflow tract presystolic flow velocity--another marker of left ventricular diastolic function. Int J Cardiovasc Imaging. 2002;18:249-56.
10. Korkmaz L, Akyuz AR, Gurbak I, Erkan H, Dursun I, Celik S. Presystolic A wave may predict increased arterial stiffness in asymptomatic individuals. Blood Press Monit. 2016;21:144-8.
11. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588- 605.
12. Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017;18:1301-10.
13. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J. 1990;11:990-6.
14. Stratos C, Stefanadis C, Kallikazaros I, Boudoulas H, Toutouzas P. Ascending aorta distensibility abnormalities in hypertensive patients and response to nifedipine administration. Am J Med. 1992;93:505-12.
15. Kasikcioglu HA, Karasulu L, Durgun E, Oflaz H, Kasikcioglu E, Cuhadaroglu C. Aortic elastic properties and left ventricular diastolic dysfunction in patients with obstructive sleep apnea. Heart Vessels. 2005;20:239-44.
16. Nadruz W. Myocardial remodeling in hypertension. J Hum Hypertens. 2015;29:1-6.
17. de Simone G, Mancusi C, Esposito R, De Luca N, Galderisi M. Echocardiography in Arterial Hypertension. High Blood Press Cardiovasc Prev. 2018;25:159-66.
18. Joshi KR, Kabirdas D, Romero-Corral A, Shah M, Figueredo VM, Pressman GS. Clinical significance of a presystolic wave on Doppler examination of the left ventricular outflow tract. Am J Cardiol. 2014;114:1599-602.
19. Akyuz AR, Turan T, Gurbak I, Korkmaz L, Agac MT, Celik S. The relationship between presystolic wave and subclinical left ventricular dysfunction in asymptomatic hypertensive patients. Blood Press Monit. 2016;21:277-81.
20. Kul S, Dursun I, Ayhan S, Sayin MR, Ucuncu O,Bulbul NE, et al. Presystolic wave is associated with subclinical left ventricular dysfunction assessed by myocardial performance index in type 2 diabetes mellitus. Arq Bras Cardiol. 2019;113:207-15
21. Dursun I, Kul S, Sahin S, Kalaycioglu E, Akyuz AR, Korkmaz L. Relation of presystolic wave on doppler examination to syntax score in patients with acute myocardial infarction. Int J Cardiovasc Imaging. 2018;34:569-76.
22. Safar ME. Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol. 2018;15:97-105.
23. Redheuil A, Wu CO, Kachenoura N, Ohyama Y, Yan RT, Bertoni AG et al. Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol. 2014;64:2619-29.
24. Sharman JE, Boutouyrie P, Laurent S. Arterial (Aortic) stiffness in patients with resistant hypertension: from assessment to treatment. Curr Hypertens Rep. 2017;19:2.
25. Nelson AJ, Puri R, Nicholls SJ, Dundon BK, Richardson JD, Sidharta SL et al. Aortic distensibility is associated with both resting and hyperemic coronary blood flow. Am J Physiol Heart Circ Physiol. 2019;317:H811-H9.
26. Razik NA, Kishk YT, Essa M, Ghany MA. Aortic Distensibility Can Predict Events in Patients With Premature Coronary Artery Disease: A Cardiac Magnetic Resonance Study. Angiology. 2021;72:332- 8.
27. Asmar R, Benetos A, London G, Hugue C, Weiss Y, Topouchian J et al. Aortic distensibility in normotensive, untreated and treated hypertensive patients. Blood Press. 1995;4:48-54.
28. Shimbo D, Shea S, McClelland RL, Viera AJ, Mann D, Newman J et al. Associations of aortic distensibility and arterial elasticity with long-term visit-to-visit blood pressure variability: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens. 2013;26:896-902.
29. Kul S, Dursun I, Sayin MR, Sahin S, Turan T, Akyuz AR et al. Presystolic wave is associated with carotid intima media thickness. Echocardiography. 2019;36:237-42.