ASSOCIATION BETWEEN ARTERIAL STIFFNESS AND LEFT VENTRICULAR FUNCTION IN HYPERTENSIVE PATIENTS

Abstract

Objective: Increased arterial stiffness is an early predictor of cardiovascular changes. However the association between arterial stiffness with LV myocardial changes is poorly understood The aim of this study was to examine the relationship between arterial stiffness and LV function in well - controlled hypertensive patients. Methods: A total 100 consecutive patients with hypertension adapted by age, gender and BMI, were separated in two groups: 27 patients with normal ventriculo - arterial coupling (VAC) and 63 hypertensive patients with disturbed VAC, measured by arterial elastance/ventricular elastance ratio(AE/Ees). All patients underwent standard two - dimentional (2D) echocardiography with Speckle tracking analysis for left ventricle (LV) global longitudinal strain (GLS). End - systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and - systolic pressure/stroke volume and end - systolic pressure/end - systolic volume. Parameters for arterial stiffness - 24 - hour central systolic pressure (cSys24 h), central pulse pressure (cPP24 h), augmentation index 24 h (Aix24 h) and 24 - hour pulse wave velocity (PWV24 h) were measured non - invasively with oscillometric method by Mobil-O-graph PWA. Results: Statistically significant differences in parameters of vascular stiffness were found in patients with normal AE/Ees ratio in comparison disturbed AE/Ees: cSys24 h (108.76 ± 7.65 vs. 115.12 ± 11.58 mm Hg, p = 0.03), cPP24 h (39.61 ± 12.25 vs. 47.12 ± 11.52 mm Hg, p = 0.03). There is a statistically significant difference in echocardiography parameters between patients with normal VAC in comparison to other group: LV - GLS (-17.98 ± 0.65 vs. -15.9 ± 1.8 %, p = 0.0001), AE (2.09 ± 0.63 vs. 1.75 ± 0.34, p = 0.003), Ees (2.89 ± 0.71vs. 4.29 ± 0.72, p = 0.0001), AE/Ees ratio (0.74 ± 0.27 vs. 0.47 ± 0.46, p = 0.003). There were no statistically significant differences in LV ejection fraction, PWV24 h, Aix24 h and heart rate between two groups. There are moderately positive correlation between cSys24 h and LVMI (r = 0.325, p = 0.001) and negative with AE/Ees (r = -0.326, p = 0.01). cPP24 h correlate positively with AE (r = 0.249, p = 0.015) and negative with E/Em (r = -0.220, p = 0.032). Conclusion: Elevated arterial stiffness was intimately determines early LV alterations, before LV dysfunction, becomes clinically evident