Abstract 1590: Association Between Arterial Stiffness, Coronary Microcirculation And Left Ventricular Function In Patients With Newly Diagnosed Arterial Hypertension.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ignatios Ikonomidis ◽  
John Lekakis ◽  
Ioannis Paraskevaidis ◽  
Helen Triantafyllidi ◽  
Costas Papadopoulos ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Diastolic Function ◽  
Coronary Flow ◽  
Left Ventricular ◽  
Coronary Microcirculation ◽  
Healthy Controls ◽  
Newly Diagnosed ◽  
Flow Reserve ◽  
Cardiovascular Morbidity And Mortality

Arterial stiffness is an independent marker of cardiovascular morbidity and mortality. Coronary microcirculation is impaired in patients with arterial hypertension. We investigated the relationship between arterial stiffness, coronary microcirculation and left ventricular (LV) systolic and diastolic function. METHODS: 80 untreated consecutive patients (mean age: 55±11 years 38 males), with newly diagnosed arterial hypertension and 20 healthy controls matched for sex, age and atherosclerotic factors, were studied. We measured a) Carotid to femoral artery pulse wave velocity (PWV) using the Complior apparatus b) Peak Systolic (Vs) and diastolic (Vd) coronary blood flow velocity, Vd/Vs ratio, Deceleration Time (DT-Vd) and time integral (VTI-Vd) of Vd using a 7MHZ transducer by means of colour-guided Doppler echocardiography at the distal tract of the LAD c) Ratio of VTI-Vd after adenosine infusion (140 μ g/kg/min) to VTI-Vd at baseline to assess coronary flow reserve (CFR) d) E and A doppler, Em, Am mitral annulus velocities TDI and E/Em ratio to assess LV diastolic function d) Mean Longitudinal, Transverse, Circumferential and Radial Strain and Strain Rate by 2-D Strain to assess LV systolic function. RESULTS: Patients and controls had normal ejection fraction. Compared to controls, patients with hypertension had higher PWV (10.4±1.7 vs. 8.2±1.4 m/s, p<0.001), E/Em (8.3±2.8 vs. 5.7±1.4, p=0.001) and lower CFR (2.6±0.6 vs. 3.4±0.7, p<0.001), Vd/Vs (1.78±0.31 vs. 1.97±0.38, p=0.04), DT-Vd (973±226 vs 1113±332 ms, p<0.001), Em/Am (0.93±0.42 vs. 1.6±0.51, p<0.001), mean longitudinal strain (−17.8±3 vs. −19.8±3.1%, p=0.031) and mean circumferential strain ( −19.6±4.5 vs. −22±3.4 %, p=0.04). Increasing PWV was related to increasing E/Em (r=0.26, p=0.045) and decreasing CFR (r=−0.68, p<0.001). Increasing E/Em was related to decreasing Vd/Vs (r=−0.3, p<0.005) and CFR (r=−0.32, p=0.002). CONCLUSIONS: Patients with arterial hypertension present subclinical systolic LV dysfunction and significant LV diastolic dysfunction compared to healthy controls. Increased LV diastolic filling pressures caused by arterial stiffness may increase the resistance of myocardial microcirculation leading to impaired coronary flow

scholarly journals The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report)

2020 ◽  
Vol 16 (2) ◽  
pp. 221-230
Author(s):  
A. I. Kochetkov ◽  
M. V. Lopukhina ◽  
E. A. Kotaeva ◽  
A. A. Kirichenko ◽  
O. D. Ostroumova
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Left Ventricular ◽  
Favorable Effect ◽  
Newly Diagnosed ◽  
Functional Changes ◽  
Collagen Formation ◽  
Cardiovascular Morbidity And Mortality ◽  
Single Pill ◽  
Left Atrial Stiffness

Arterial hypertension (AH) is one of the most significant modifiable risk factors that increase cardiovascular morbidity and mortality worldwide, including Russia. The complex of structural and functional changes in the heart that occurs during AH consists not only in the formation of left ventricular (LV) myocardial hypertrophy, but also in the myocardial stiffness increasing due to collagen formation and cardiomyocytes apoptosis. These abnormalities are substrate for diastolic function disturbances, electrical myocardial instability and ischemia. The article provides a clinical case of amlodipine/lisinopril single-pill combination (A/L SPC) use in real clinical practice in a patient with stage II grade 2 newly diagnosed AH and its effect on blood pressure and echocardiographic myocardial fibrosis markers, including speckle tracking parameters The high antihypertensive efficacy of A/L SPC, a favorable effect on blood pressure circadian rhythm, as well as pronounced target-organ protective properties, in particular the ability to reduce LV and left atrial stiffness, were demonstrated. So, we conclude that A/L SPC improve the elastic properties of the left heart.

Abstract 2687: Arterial Stiffness Determines Baseline Coronary Flow And Flow Reserve In Untreated Patients With Arterial Hypertension

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ignatios Ikonomidis ◽  
John Lekakis ◽  
Helen Triantafyllidi ◽  
Costas Papadopoulos ◽  
Georgia Georgoula ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Coronary Flow ◽  
Subclinical Atherosclerosis ◽  
Prognostic Significance ◽  
Multivariate Regression Analysis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Time Integral ◽  
Flow Reserve

Arterial stiffness is a marker of subclinical atherosclerosis with prognostic significance. Coronary microcirculation is disturbed in patients with arterial hypertension. We investigated whether the arterial stiffness may determine baseline coronary flow and flow reserve (CFR) in never-treated hypertensives. METHODS: We studied 100 untreated consecutive patients (mean age: 55±11 years 53 male and 47 females), with newly diagnosed arterial hypertension and 20 controls matched for sex, age and atherosclerotic factors, Exclusion criteria were history of diabetes, familiar hyperlipidemia, CAD, cardiomyopathy and chronic obstructive pulmonary disease. We measured a) Carotid to femoral artery pulse wave velocity (PWV) as an estimate of arterial stiffness using the Complior apparatus b) Peak Systolic (Vs) and diastolic (Vd) coronary blood flow velocity , Vd/Vs ratio, Deceleration Time (DT-Vd) and time integral (VTI-Vd) of Vd using a 7MHZ transducer by means of colour-guided Doppler echocardiography at the distal tract of the LAD c) Ratio of VTI-Vd after adenosine infusion (140μg/kg/min) to VTI-Vd at baseline to assess coronary flow reserve (CFR) RESULTS: All patients had normal LVmass (men<134gr/m2, women <110gr/m2) and had higher PWV (10.4±1.7 vs. 8.2±1.4 m/s, p<0.001) and lower CFR, Vd/Vs and DT-Vd (2.6±0.6 vs 3.4±0.7, p<0.001, 1.78±0.31 vs. 1.97±0.38, p=0.04 and 973±226 vs. 1113±332 ms, p<0.001 respectively) than controls. Increasing PWV was related to decreasing Vd/Vs (r=-0.65, p<0.001) , DT-Vd (r=-0.8, p<0.001), CFR (r=-0.7, p<0.001) and VTI-Vd post adenosine (r=-0.24, p=0.034). In multivariate regression analysis, PWV and smoking were the most important determinants of CFR among age, sex, body mass index, mean blood pressure and hyperlipidemia (b: - 2.21, p<0.001 and b: - 2.68, p=0.032 respectively). Patients with CFR>2 had significantly lower PWV, than those with CFR<2 (n=20) (10±1.5 vs. 12±2 m/s p<0.001). By ROC analysis, a PWV>10.7 m/sec predicted a CFR < 2 with a 84% and 80% sensitivity and specificity respectively. CONCLUSIONS: Arterial stiffness determines with baseline coronary flow and flow reserve in never treated hypertensives with no evidence of LV hypertrophy.

scholarly journals Στεφανιαία εφεδρεία ροής και διαστολική απόδοση της αριστερής κοιλίας σε ασθενείς με χρόνια νεφρική νόσο

2020 ◽  
Author(s):  
Λάμπρος Λάκκας
Keyword(s):  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Coronary Flow ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Ventricular Diastolic Function ◽  
Flow Reserve ◽  
Echocardiographic Evaluation ◽  
Before And After

lntroduction-Aim of the studv: Chronic kidney disease (CKD) is related to higher risk for cardiovasular related morbidity and mortality. lt seems that this risk is higher even in the presence of early abnormal indices related to functionality of the left ventricle orland abnormal coronary flow reserve (CFR). Aim of this study was a) to investigate diastolic dysfunction and CFR after dipyridamole infusion in CKD patients, b) to inspect changes in diastolic dysfunction of the left ventricle after dipyridamole infusion in these patients and c) to compare the aforementioned indices between CKD patients and healthy controls, as also between patients with CKD and patients with a hisotry of renal transplantation Tx. Materials and methods: This study included 60 CKD patients from the outpatient CKD clinic of University Hospital of loannina, 30 healthy controls and 50 patients with Tx history. All patients and healthy controls were evaluated thoroughly (clinical examination, lab exams and echocardiographic evaluation). The echocardiographic evaluation included transthoracic echocardiogram, dipyridamole infusion for coronary flow reserve (CFR) evaluation in the left anterior descending coronary artery and at the end of the this stress test, a new transthoracic echocardiogram.ln a subgroup of Tx patients, the whole evaluation was repeated after 3 years. Results: Mean CFR value [t standard deviation (SD)] for CKD patients was 2.98 (t0.83).Deformation related echocardiographic indices urere normal [mean values (t) SD: GLS -20.5 (t3.1)o/o, τWlsT s.07(t4.41)", UNTW|Sτ -69.2(t30)"/sec]' Patients with advanced CKD (GFR<3omllminl1'73m2), had bigger left ventricle mass (p<0.037), without any other differences comparing to other patients as far as echocardiographic indices related to systolic and diastoliο left ventricular function were concerned. CKD patients had lower CFR comparing to healthy controls. There \rvere no differences of statistical importance between these two populations, in left ventricular functional indices. After dipyridamole infusion, there was a significant improvement (p<0.05) in all left venticular functionality related echoοardiographic indices in both populations.Tx patients had bigger left atrial volume (p=0.014), lower CFR mean value (p=0.007) and better left ventricular diastolic function shown by UΝTW|SΤ (p=0.035) comparing to CKD patients. There ιΛ/ere no differenοes in echocardiographic indices'changes before and after dipyridamole infusion. ln Tx patients that were re-evaluated after 3 years (N=45), a deterioration was shown in most of echocardiographic indices [increase in left ventricuΙat mass (ρ=0.009), decrease in left ventricular ejection fraction (p=0.001), increase in E/e'(p=0.002), deterioration in TW|ST (p=0.002) and UNTW|ST (p=9.935μ. Conclusion: Patients with CKD have lower CFR values comparing to healthy controls and higher than patients with a history of Tx. Tx patients had better left ventricular diastolic function than CKD patients. There \Λrere no significant differrences in various echocardiographiο indices before and after dipyridamole infusion, in all subgroups of patients in this study. Larger-scale studies are mandatory to clarify the clinical importance of various echocardiographic indices in different CKD stages.

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