Ultrasound investigation of the brachial artery diameter as a non-invasive method for exposure of endothelial dysfunction in patients with ischemic heart disease and concomitant gastroesophageal reflux disease

Abstract

Objective — to assess endothelial dysfunction in patients with ischemic heart disease (IHD) with concomitant gastroesophageal reflux disease (GERD) with the use of high-quality ultrasound imaging of the brachial artery.Materials and methods. The study involved 100 patients, who were divided into two groups. The first group included 60 patients (43 male (71.7 %), 17 female (28.3 %)) aged 42 to 60 years (the mean age 53.79 ± 3.9 years) with IHD and concomitant nonerosive form of GERD. Second group included 40 patients (28 (70 %) male, 12 (30 %) female) aged 39 to 60 years (the mean age 53.0 ± 4.6 years) with IHD without comorbidites. The control group consisted of 20 healthy participants with matching age (mean 47 ± 6.1 years old) and gender (7 (35 %) male, 13 (65 %) female). The IHD diagnosis was established according to ICD-10, Unified clinical protocol for primary, secondary and tertiary care «Stable ischemic heart disease», 2013 European Society of Cardiology guidelines on the management of stable coronary artery disease. The GERD diagnosis was made according to ICD-10 and The Montreal definition and classification of gastroesophageal reflux disease (2006). BP was measured by the Scipione Riva-Rocci/Korotkoff method using Microlife BP AG1 — 20 sphygmomanometer (Switzerland) after 10 minutes rest in sitting and supine positions to measure systolic BP. Measurements of endothelial dysfunction were conducted using reactive hyperemia test and nitroglycerine test. Brachial artery (BA) diameter measurement was conducted on Aloka-SSD-650 ultrasound scanner (Japan) using high-definition linear probe. All collected data were entered into the electronic database. Statistical processing was performed with variation and nonparametric biomedical statistics using Excel for Windows, Statistica 6.0 and SPSS Statistics statistical software. Statistical significance was determined using Student’s t-test and Wilcoxon signed-rank test. The difference in results was considered statistically significant with p-value < 0.05.Results. The obtained results showed a significant difference in BA diameter measurements between both groups of patients and control group. At the same time, the difference in BA diameter measurements between first and second study groups was not significant, while difference in BA diameter measurements between second study group and control group was significant. After conducting reactive hyperemia tests, the significantly decreased rate of BA diameter increase (p < 0.001) was noted in patients with IHD with concomitant GERD, both compared to control group and patients with IHD without comorbidities. After sublingual nitroglycerine, the significantly (p < 0.001) increased rate of BA diameter increase was defined in all study groups, evidencing the probe adequacy.Conclusions. The non-invasive high-quality ultrasound Doppler scan method to determine brachial artery dilatation during occlusion test can be used to evaluate degree of endothelial dysfunction both in people with cardiovascular diseases and people with other pathologies with underlying abnormal endothelial function.