Non-invasive Systemic Hemodynamic Index in Vascular Risk Stratification Tailored for Hypertensives.

Jianning Zhang,Jiawen Liang,Jiang He,Xiaoyu Zhang,Yumin Qiu,Zhichao Wang,Shiyue Xu,Jun Tao,Qiang Tu,Chen Su,Zhe Zhou,Wenhao Xia,Bing Dong

doi:10.3389/fcvm.2021.744349

Abstract

Vascular dysfunction is a key hallmark of hypertension and related cardiovascular outcomes. As a well-known hemodynamic disease, hypertension is characterized by abnormal ventricular-vascular interactions. Complementing non-invasive systemic hemodynamics in hypertensive vascular risk assessment is of promising significance. We aimed to investigate the effects of abnormal hemodynamic states other than elevated blood pressure on vascular damage and establish a united index of systemic hemodynamics for generalized vascular risk evaluation. Non-invasive systemic hemodynamics, assessed by impedance cardiography, was compared among blood pressure stages. Vascular function was evaluated by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV). Systemic hemodynamics was obtained from a total of 88 enrollees with a mean (±SD) systolic blood pressure 140 (±17) mm Hg, and aged 17 to 91 years. Both stroke systemic vascular resistance index and left stroke work index exhibited a significant alteration among blood pressure stages (p < 0.001; p = 0.01, respectively), whereas heterogeneous hemodynamic and vascular function subsets existed within similar blood pressure. In addition, blood pressure categories failed to recognize between-group differences in endothelial dysfunction (p = 0.88) and arterial stiffness (p = 0.26). An increase in myocardial contractility and a parallel decrease in afterload was associated with the decline of vascular dysfunction. Systemic Hemodynamic Index (SHI), as a surrogate marker, demonstrated a significantly negative correlation with vascular damage index (VDI, r = −0.49, p < 0.001). These findings illustrate that systemic hemodynamics underlying hypertensives provides more vascular information. The SHI/VDI score may be a feasible tool for cardiovascular function assessment.

Highlights

1.13 billion people worldwide suffer from hypertension [1], which is the leading cause of premature death [2,3,4]
Our study revealed that cardiac index (CI) exhibited a moderate positive correlation with flow-mediated dilation (FMD), as well as left stroke work index (LSWI)/systemic vascular resistance index (SSVRI) ratio (Figures 2A,B)
To establish a surrogate marker for promising clinical practice, this state-ofart study defines an integrated Systemic Hemodynamic Index (SHI) that inversely correlates with vascular dysfunction and provides information for cardiovascular function assessment tailored for hypertension

Summary

Introduction

1.13 billion people worldwide suffer from hypertension [1], which is the leading cause of premature death [2,3,4]. Elevated blood pressure, accompanied by other cardiovascular risk factors, contributes to vascular dysfunction [7, 8]. Dual standardization of blood pressure and vascular function may be optimal for hypertension residual risk management. Large arterial stiffness has been viewed as a robust independent predictor of cardiovascular events and all-cause mortality in hypertensives [9, 10]. Intensive blood pressure control is beneficial for attenuation of increases in arterial stiffness, which may account for reduced cardiovascular morbidity and mortality in the Systolic Blood Pressure Intervention Trial (SPRINT) trial [11, 12]. Our recent data pooled from a largescale community-based Chinese cohort further reveal that arterial stiffness is associated with worse clinical outcomes than blood pressure alone [13]. We propose that the concept of integrated vascular damage index (VDI) provides the framework to develop surrogate markers to identify hypertensives with varied vascular conditions

Objectives

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Conclusion