Derya TOK, Fırat ÖZCAN, İskender KADİFE, Osman TURAK, Nurcan BAŞAR, Kumral ÇAĞLI, Sinan AYDOĞDU

Metabolik sendromlu hastalarda aortun elastik özellikleri ve aort sertliğini etkileyen faktörler

Amaç: Metabolik sendromda aortik sertlikte artış olması beklenmektedir. Çalışmamızda metabolik sendrom (MetS)’lu hastalarda aortik sertlik ve bununla ilişkili ekokardiyografik ve biyokimyasal parametreleri saptamayı amaçladık. Gereç ve yöntem: Çalışmaya güncellenmiş ATP III kriterlerine göre MetS tanısı alan ardışık 46 hasta (25 erkek, ortalama yaş 47.3±6.6 yıl) ve 44 kontrol (18 erkek, ortalama yaş 46.0±6.1yıl) hastası alındı. M-mode ekokardiyografi ile aortik strain, distensibilite ve sertlik indeksi hesaplandı. Ekokardiyografik olarak diastolik parametrelerin ölçümü yapıldı. Bulgular: Ekokardiyografik parametrelerden sol ventrikül kitle indeksi, deselerasyon zamanı (DZ), izovolümetrik relaksasyon zamanı (İVRZ) MetS’lu hastalarda kontrol grubuna kıyasla yüksek ve mitral E/A oranı ise düşük saptandı. MetS’lu hastalarda kontrol grubuna kıyasla aortik distensibilite anlamlı düşük (10.4±3.5’e cm2. dyn-1.10-6 karşılık 12.7±3.4 cm2.dyn-1.10-6, p=0.002), sertlik indeksi ise anlamlı yüksek saptandı (6.5±2.0’e karşılık 3.2±0.8, p

Elastic properties of the aorta and factors affecting aortic stiffness in patients with metabolic syndrome

Objectives: In this study, we evaluated aortic stiffness and echocardiographic and laboratory factors affecting aortic stiffness in patients with metabolic syndrome (MetS). Materials and methods: Forty-six patients (25 male, mean age 47.3±6.5 years) with the diagnosis of MetS according to the Adult Treatment Panel III Final Report criteria were included. Forty-four age and gender matched healthy subjects (18 male, mean age 46.0±6.1 years) were recruited as the control group. Aortic strain, distensibility and stiffness index were calculated by M-mode echocardiography and diastolic parameters were measured. Results: Left ventricular mass index (LVMI), deceleration time (DT), isovolumic relaxation time (IVRT) were increased and mitral E/A ratio was decreased in patients with MetS compared to controls. In the MetS patients, aortic distensibility was significantly decreased (10.4±3.5 cm2.dyn-1.10-6 vs. 12.7±3.4 cm2.dyn-1.10-6, p=0.002), and ASI was significantly increased (6.5±2.0 vs. 3.2±0.8, p<0.001). ASI was positively correlated with triglycerides, fasting glucose, uric acid, hsCRP, LVMI, DT, IVRT and systolic blood pressure level, and was negatively correlated with HDL-cholesterol and mitral E/A ratio. In regression analysis, hsCRP (p=0.05) and systolic blood pressure level (p<0.001) were independent predictors of ASI. Conclusions: ASI is increased in patients with MetS. In these patients; decrease in aortic elasticity properties was associated with left ventricular diastolic dysfunction. High systolic pressure and hsCRP levels were found to be independent predictors of ASI.

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1. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008;28(4):629-36.
2. Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006;119(10):812-9.
3. Motillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010;56(14):1113-32.
4. Zanetti M, Bosutti A, Ferreira C, et al. Circulating pentraxin 3 levels are higher in metabolic syndrome with subclinical atherosclerosis: evidence for association with atherogenic lipid profile. Clin Exp Med 2009;9(3):243-8.
5. Arnett DK, Evans GW, Rİley WA. Arterial stiffness a new cardiovascular risk factor. Am J Epidemiol. 1994;140(8):669682.
6. Kostis J, Lawrence-Nelson J, Ranjan R, Wilson A, Kostis W, Lacy C. Association of increased pulse pressure with the development of heart failure in SHEP.Systolic Hypertension in the Elderly (SHEP) Cooperative ResearchGroup. Am J Hypertens 2001;14(8):798–803.
7. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM.Impact of aortic stiffness on survival in endstage renal disease. Circulation 1999;99(18):2434–9.
8. Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: a predictor of long-term cardiovascular mortality in a french male population. Hypertension 1997;30(6):1410–5.
9. Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME. Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. Arterioscler Thromb 1993;13(1):90 –7.
10. Lacombe F, Dart A, Dewar E, et al. Arterial elastic properties in man: a comparison of echo–Doppler indices of aortic stiffness. Eur Heart J 1992;13(8):1040-5.
11. Nicole M, Van Popole MD, Diederick E. Association between arterial stiffness and atherosclerosis. The Rotterdam Study. Stroke 2001;32(2):454-60.
12. Third Report of the National Education Program (NCEP) Expert Panel on Detection ,Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.
13. Lenfant C, Chobanian AV, Jones DW et al. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7):resetting the hypertension sails. Hypertension 2003;41(6):1178-9.
14. Cheitlin MD, Alpert JS, Armstrong WF et al. ACC/AHA guidelines fort he clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997;95(6):1686-744.
15. Devereux RB, Reichek N. Echocardiographic determination of the left ventricular mass in man. Anatomic validation of the method. Circulation 1977;55(4):613-8.
16. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouza P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthly men and in men with coronary artery disease. Eur Heart J 1990;11(11):990-6.
17. D’Andrea A, Cocchia R, Reigler L, et al. Aortic stiffness and distensibility in top-level athletes. J Am Soc Echocardiography 2012;25(5):561-7.
18. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37(5):1236-41.
19. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease?The Framingham Heart Study. Circulation 1999;100(4):354-60.
20. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288(21):2709-16.
21. Ford ES. The metabolic syndrome and mortality from cardiovascular disease and all-causes: Findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis 2004;173(2):309-14.
22. Satoh H, Kishi R, Tsutsui H. Metabolic syndrome is a significant and independent risk factor for increased arteriel stiffness in Japanes subjects. Hypertens Res 2009;32(12):1067- 71.
23. Li CI, Kardia S, Liu CS, et al. Metabolic syndrome is associated with change in subclinical arteriel stiffness- A community- based Taichung Community Health Study. BMC Public Health 2011;11:808-16.
24. van Popele NM, westendorp IC, Bots ML, et al. Variables of the insulin resistance syndrome are associated with reduced arterial distensibility in healthly non-diabetic middle-aged women. Diabetologia 2000;43(5):665-72.
25. Sutton-Tyrell K, Newman A, Simonsick EM, et al. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition. Hypertension 2001;38(3):429-33.
26. Emre A, Oz D, Yesilcimen K, Sayar N, Ergun D. Impact of the metabolic syndrome on aortic pulse pressure and ascending aortic pulsatility in patients with angiographically normal coronary arteries. Can J Cardiol 2009;25(7):411-4.
27. Stehouwer CD, Henry RM, Ferreira I. Arteriel stiffness in diabetes and the metabolic syndrome:a pathway to cardiovascular disease. Diabetologia 2008;51(4):527-39.
28. Schillaci G, Pirro M, Vaudo G, et al. Metabolic syndrome is associated with aortic stiffness in untreated essential hypertension. Hypertension 2005;45(6):1078-82.
29. Sipila K, Koivistoinen T, Moilanen L, et al. Metabolic syndrome and arteriel stiffness: The Health 2000 Survey. Metab Clin Expl 2007;56(3):320-6.
30. Eren M, Gorgulu S, Uslu N, et al. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart 2004; 90(1):37- 43.