Left ventricular diastolic dysfunction is accompanied by increased aortic stiffness in the early stages of essential hypertension: a TDI approach

Tsioufis, Costas; Chatzis, Dimitrios; Dimitriadis, Kyriakos; Stougianos, P.; Kakavas, A.T.; Vlasseros, I.; Tousoulis, Dimitris; Stefanadis, Christodoulos; Kallikazaros, Ioannis

doi:10.1097/01.hjh.0000174394.57644.69

Cited by 71 publications

(60 citation statements)

References 30 publications

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“…10 LV diastolic function was determined using both conventional Doppler parameters (peak velocities of E and A waves of the transmitral flow, E/A ratio, isovolumic relaxation time and the deceleration time of the E wave) and Tissue Doppler Imagingderived indices (peak early diastolic velocity (Em), peak atrial systolic velocity (Am)), averaging the mean values obtained from measurements at the basal site of lateral, septal, anterior and inferior walls in five consecutive cardiac cycles, as previously described. 11 Arterial tonometry All patients were studied in the early morning at the day of catheterization at the catheterization lab, with patients in the fasting state for 412 h. Radial artery pressure waveforms were recorded using applanation tonometry (SphygmoCor; AtCor Medical, Sydney, Australia). A high-fidelity micromanometer placed on the tip of a pencil-type hand-held tonometer (Millar Instruments, Houston, TX, USA) was applied to the surface of the skin overlying the radial artery with gentle pressure so as not to occlude the artery.…”

Section: Cardiac Ultrasonographymentioning

confidence: 99%

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

et al. 2011

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Subendocardial viability ratio (SEVR), calculated through pulse wave analysis, is an index of myocardial oxygen supply and demand. Our aim was to evaluate the relationship between coronary flow reserve (CFR) and SEVR in 36 consecutive untreated hypertensives (aged 57.9 years, 12 males, all Caucasian) with indications of myocardial ischaemia and normal coronary arteries in coronary angiography. CFR was calculated by a 0.014-inch Doppler guidewire (Flowire, Volcano, San Diego, CA, USA) in response to bolus intracoronary administration of adenosine (30-60 lg). SEVR was calculated by radial applanation tonometry, while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Hypertensive patients with low CFR (n ¼ 24) compared with those with normal CFR (n ¼ 12) exhibited significantly decreased SEVR by 24.5% (P ¼ 0.002). In hypertensives with low CFR, CFR was correlated with SEVR (r ¼ 0.651, P ¼ 0.001). After applying multivariate linear regression analysis, age, left ventricular mass index, Em/Am, 24-h diastolic blood pressure (BP) and SEVR turned out to be the only independent predictors of CFR (adjusted R 2 ¼ 0.718). Estimation of SEVR by using applanation tonometry may provide a reliable tool for the assessment of coronary microcirculation in essential hypertensives with indications of myocardial ischaemia and normal coronary arteries.

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Section: Cardiac Ultrasonographymentioning

confidence: 99%

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

et al. 2011

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“…Measurements of c-f PWV were performed by two trained clinicians who were familiar with the technique, in controlled room temperature with constant noise and light intensity, by using a validated non-invasive automatic device (Complior SP; Artech Medical, Pantin, France), as has been described previously. 17 In each patient, five consecutive measurements of c-f PWV were performed and the mean value was obtained.…”

Section: Cardiac Echocardiographymentioning

confidence: 99%

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

et al. 2010

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The data regarding the role of serum uric acid (SUA) along with subclinical inflammation in the context of hypertensive vascular damage are rather scarce and controversial. Towards this end, we assess the links between SUA, high-sensitivity CRP (hs-CRP), adiponectin and carotid to femoral pulse wave velocity (c-f PWV) in 292 subjects with never-treated stage I-II essential hypertension. On the basis of the median SUA levels (0.31 mmol l À1 ), the study population was divided into subjects with low (n ¼ 149) and high (n ¼ 143) SUA values. By multiple regression analysis, it was revealed that SUA was independently associated with log hs-CRP (R 2 ¼ 0.098; P ¼ 0.02), log adiponectin (R 2 ¼ 0.102; P ¼ 0.03), waist circumference (R 2 ¼ 0.049; P ¼ 0.04), 24-h systolic blood pressure (SBP) (R 2 ¼ 0.179; P ¼ 0.001) and estimated glomerular filtration rate (R 2 ¼ 0.156; b (s.e.) ¼ À0.169 (0.023); P ¼ 0.02). In addition, c-f PWV was independently associated with age (R 2 ¼ 0.116; Po0.0001), waist circumference (R 2 ¼ 0.088; Po0.0001), 24-h SBP (R 2 ¼ 0.167; P ¼ 0.001), log adiponectin (R 2 ¼ 0.07; P ¼ 0.006) and log hs-CRP (R 2 ¼ 0.06; P ¼ 0.034). In conclusion, SUA levels are independently associated with hs-CRP and adiponectin levels but not with c-f PWV in essential hypertensive patients. Increased SUA levels are accompanied by a state of pronounced inflammatory activation and hypoadiponectinemia that significantly impairs the arterial stiffness accelerating the vascular ageing process in this setting.

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“…21 Left ventricular diastolic function was determined using both conventional Doppler parameters (E/A waves ratio of the transmitral flow, isovolumic relaxation time, deceleration time of the E wave and the peak velocities of E and A waves) and tissue Doppler imaging (TDI)-derived indices (peak early diastolic velocity (Em) and peak atrial systolic velocity (Am)), averaging the mean values obtained from measurements at the basal site of lateral, septal, anterior and inferior walls in five consecutive cardiac cycles, as described earlier. 22 Statistical analysis SPSS statistical package, release 12.0 (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses. All descriptive continuous variables are presented as means and standard deviations because of their normal distribution.…”

Section: Study Populationmentioning

confidence: 99%

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

et al. 2009

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We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m -2 , Po0.01 and 1.4 mm m -2 , P ¼ 0.003, respectively) or LV-CR (by 1.3 mm m -2 , P ¼ 0.003 and 1.6 mm m -2 , P ¼ 0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m -2 , Po0.001 and 3.4 ml m -2 , Po0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m -2 , respectively, Po0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

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Left ventricular diastolic dysfunction is accompanied by increased aortic stiffness in the early stages of essential hypertension: a TDI approach

Abstract: TDI-detected LV diastolic dysfunction is accompanied by increased aortic stiffness in newly diagnosed essential hypertension, suggesting that there may be a common pathophysiological pathway linking these two entities.

Cited by 71 publications

References 30 publications

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

Left ventricular mass but not geometry determines left atrial size in the early stages of hypertension

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