Mortality in cyanotic patients with congenital heart diseases (CHD) is very high, mainly due to cardiovascular complications. It is known that endothelial dysfunction, increased arterial stiffness, impaired vascular function have negative influence on cardiovascular prognosis. Aim of study was to assess parameters of arterial stiffness and vascular dysfunction in cyanotic patients with CHD as well as their potential relation to impaired blood oxygen saturation and polycythemia parameters typical for cyanosis.Design and method:
36 cyanotic patients with congenital heart disease (17 males) aged 20–72 (42.3 ± 16.3 years); control group: 35 healthy individuals (16 males) aged 23–52 (39.6 ± 10.4 years). Assessed parameters: of central aortic pulse wave analysis (AoSP-aortic systolic pressure, AoPP-aortic pulse pressure, AP-augmentation pressure, AI-Augmentation Index, PPampl- pulse pressure amplification) and pulse wave velocity (PWV) with applanation tonometry method; IMT (intima media thickness) and FMD (flow-mediated dilatation after hyperemia) with USG Doppler.Results:
AoPP (37.3 ± 11.1 vs. 29 ± 6.5mmHg; p = 0.002), AP (10.1 ± 7.3 vs. 1.1 ± 3.9 mmHg; p = 0.00001), and AI (24.7 ± 13.5 vs. 3.0 ± 13.6%; p = 0.00001) were higher in the studied group compared to the controls. Higher values of PWV (7.4 ± 2.1 vs. 6.3 ± 0.7 m/s; p = 0.003) and lower of PPampl (135.3 ± 16.1 vs. 160.4 ± 12.8%; p = 0,00001) in the studied population proved presence of the increased stiffness of arteries compared with the control group. IMT was on the border of statistical significance (0.06 ± 0.02 vs. 0.05 ± 0.01 mm; p = 0.051). In cyanotic patients impairment of FMD was observed as compared with controls (9.0 ± 5.6 vs. 10.9 ± 4.7; p = 0.04). No significant correlations were found between AoSP, AoPP, AP, AI, PWV, PPampl, IMT, FMD and biochemical parameters characterizing cyanotic patients depicting rheological properties of blood (SaO2, HGB, HCT, RBC).Conclusions:
Cyanotic patients with congenital heart diseases are characterized by significantly increased arterial stiffness estimated with pulse wave analysis parameters (AI, PPampl) and PWV, as well as by deteriorated arterial function expressed with worse vasodilatative response in comparison with healthy age-adjusted population. It may confirm relevance of those mechanisms in development of increased rate of cardiovascular events in this population. Association between oxygen saturation or polycythemia and arterial stiffening and vascular dysfunction was not found in this group of patients.