P962The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension


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Abstract

Background: The interest in the role of arterial stiffness (a.s.) in left ventricular (LV) diastolic dysfunction (d.d.) pathomechanism has been growing recently. The aim of the study was to examine the relationship between local carotid a.s. parameters assessed by new ultrasonic high-resolution echo-tracking method (eT) and LV diastolic function indices in patients with untreated hypertension (H).Methods: The study group consisted of 173 subjects, 78 M and 95 F, 113 with untreated H, mean age 55,7± 10,4 years, and 60 age matched controls. From 2D Echo, conventional and Tissue Doppler echocardiography LV systolic and diastolic function and LVH indices were assessed. Hypertensives were divided into two groups: with diastolic dysfunction (H d.d.+: with relaxation abnormalities, n=55 and with pseudonormalization pattern, n=12) and without diastolic dysfunction (H d.d-, n=46). From carotid arteries ultrasound - intima media thickness (IMT) and eT a.s.parameters were evaluated: β- beta, Ep - epsilon, AC- arterial compliance, PWV β -one-point pulse wave velocity and AI - augmentation index as well.Results: The linear regression analysis revealed the significant correlations between a.s. indices and diastolic function parameters in the study groups: E/A correlated to Ep, β, AC and PWV β (r = -0.30, r = -0.25, r = 0.26, r = -0.30 respectively, P < 0.05); e' correlated to Ep, β and PWV β (r = -0.22, r = -0.26, r = -0.25 respectively, P < 0.05); e'/a' was correlated with β and PWV β (r = -0.28, r = -0.28 respectively, P < 0.05). Hypertensives with d.d.+ did not present echocardiographic LVH. Univariable analysis revealed the following significant variables in determining of LV d.d.: β > 9.2 (OR 2.65, P = 0.026), Ep > 118 kPa (OR 3.53, P = 0.040), PWV β >6,2 m/s (OR 3.92, P = 0.002), AI > 7.8 (OR 2.62, P = 0.049), age >54 (OR 4.76, P < 0.001), diabetes presence (OR 2.78, P = 0.013), IMT > 0.51 mm (OR 4.49, P < 0.001), diastolic blood pressure <70 mmHg (OR 3.38, P = 0.047), pulse pressure > 64 (OR 2,90, P = 0.031) and ejection fraction <76 (OR 3.38, P = 0.019). However at multivariate analysis only: age (OR = 2.43, P = 0.073), IMT (OR = 4.56, P = 0.002) and PWV β (OR = 2.18; P = 0.091) were independently associated with d.d. occurrence.Conclusion: Early carotid arteries structural and functional abnormalities are associated with LV early diastolic dysfunction in untreated middle-aged hypertensives. This relationship may precede LVH development in H and support the hypothesis of contribution of arterial stiffness to LV diastolic dysfunction pathomechanism.

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