Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives

Abstract

We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P < .05). In hypertensives, increased PBR was associated with increased cSBP, PWV, and decreased CFR and GLS after adjustment for age, sex, BMI, smoking LV mass, heart rate, hyperlipidemia, and office SBP (P < .05). PBR had an additive value to PWV, CFR, and office SBP for the prediction of abnormal GLS (x 2 = 2.4-3.8, P for change = .03). Endothelial glycocalyx is impaired in untreated hypertensives and is related to arterial stiffness, coronary, and myocardial dysfunction. | 673IKONOMIDIS et al.reserve (CFR), a marker of coronary microcirculatory function, is related to arterial stiffness and is impaired in hypertensive heart disease. 22 The effect of endothelial glycocalyx damage on arterial wall properties, coronary flow reserve, and LV myocardial deformation has not been clarified.We hypothesized that endothelial glycocalyx is impaired in newly diagnosed untreated hypertensives, leading to impaired arterial elasticity, coronary flow reserve, and consequently, abnormal myocardial deformation. Therefore, we investigated the association of endothelial glycocalyx damage with pulse wave velocity, coronary flow reserve, and LV myocardial deformation in untreated hypertensives. | MATERIAL S AND ME THODS | Study populationOut of 348 consecutive patients with new onset essential hypertension who attended our outpatient hypertension clinic, 320 patients (mean age: 51 ± 11 years, 67% males) with normal ejection fraction (>60%) had adequate 2-dimensional echocardiography images for the analysis of speckle parameters (feasibility of the method 92%). The diagnosis of essential hypertension was defined as One-hundred and sixty normotensive individuals (age:48 ± 13 years, 66% males) who visited our outpatient clinic for a routine check-up were selected using a ratio of 1 control to 2 hypertensive patients as controls.Exclusion criteria were history of diabetes, familiar hyperlipidemia, coronary artery disease (CAD), cardiomyopathy, and chronic pulmonary disease. All patients and controls had no history of CAD, normal resting electrocardiogram, and underwent a non-invasive test (thallium scintigraphy after a treadmill exercise test or dobutamine stress echocardiography) to exclude myocardial ischemia. None of the female patients were on hormone replacement treatment. None of the patients or controls were on any kind of medication, including statins. All patients and controls had a glomerular filtration rate (GFR) > 60 mL/min/1.732 (MDRD formula) at enr...

Pulse wave velocity to global longitudinal strain ratio in hypertension

“…The clinical value of carotid‐femoral PWV and LV GLS measurement in hypertensive patients has been widely investigated. PWV measurement is linked to disease progression and is recommended by current guidelines . Also GLS is relatively easily calculated from standard echocardiographic studies and provides an early marker of LV dysfunction even in the absence of LV hypertrophy .…”

“…GLS analyses were executed by two independent observers blinded to clinical and demographic data. Inter and intra observer variability of GLS have been previously reported for our laboratory (8% and 5%, respectively) …”

“…Coronary flow reserve was calculated with the use of transthoracic Doppler Echocardiography (Vivid E9, GE Medical Systems, Horten Norway) as indicated . Specifically, mid‐distal left anterior descending artery was recognized in long axis apical views with the use of a 7 MHz transducer.…”

“…Peak flow velocity values of pre and post adenosine infusion were averaged. Subsequently, CFR was derived as the ratio between hyperaemic peak flow and baseline peak flow velocities according to previously used methodology …”

“…Moreover, global longitudinal strain (GLS) has been extensively studied in hypertensive patients and has been proposed as an early marker of subclinical LV contractile dysfunction in newly diagnosed hypertension . A common pathophysiology pathway involving endothelial dysfunction and aortic fibrosis combined with LV collagen accumulation and coronary microcirculatory dysfunction has also been proposed for hypertensives …”