2Department of Cardiology, Faculty of Medicine, Kafkas University; Kars-Turkey
3Department of Cardiology, Erzurum Regional Training and Research Hospital; Erzurum-Turkey
4Department of Cardiology, Gaziemir State Hospital; İzmir-Turkey
5Department of Radiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon-Turkey
Abstract
Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction <50%, history of significant coronary artery disease, chronic renal failure, atrial fibrillation/ flutter, second or third-degree atrioventricular block, moderate to severe valvular heart disease, history of cerebrovascular disease, non-dipper hypertensive pattern and sleep apnea. The study was composed of 121 hypertensive diabetic patients. Twenty-four-hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between ambulatory arterial stiffness index and left atrial functions was analyzed. AASI was calculated as 1 minus the regression slope of diastolic BP plotted against systolic BP obtained through individual 24-h ABPM. Results: The univariate analysis showed that ambulatory arterial stiffness index was positively correlated with age (r=: 0.287, p=: 0.001), hypertension duration (r=: 0.388, p<0.001), fasting plasma glucose (r=: 0.224, p=: 0.014), HbA1c (r=: 0.206, p=: 0.023), LDL cholesterol (r=: 0.254, p=: 0.005), and also overall pulse pressure (r=: 0.195, p=: 0.002), office- pulse pressure (r=: 0.188, p=: 0.039), carotid intima-media thickness (r=: 0.198, p=: 0.029), E/E’ (r=: 0.248, p=: 0.006), and left atrial volume index (r=: 0.237, p=: 0.009). Moreover, ambulatory arterial stiffness index was negatively correlated with eGFR (r=: (-) 0.242, p=: 0.008), peak left atrial strain during ventricular systole [S-LAs (r=: (-) 0.654, p<0.001)], peak left atrial strain at early diastole [S-LAe (r=: (-)0.215, p=: 0.018)], and peak left atrial strain rate during ventricular systole [SR-LAs (r=: (-) 0.607, p<0.001)]. The multiple linear regression analysis showed that ambulatory arterial stiffness index was independently associated with peak left atrial strain rate during ventricular systole (SR-LAs) (p<0.001). Conclusion: In hypertensive diabetic patients, increased ambulatory arterial stiffness index is associated with impaired left atrial functions, independent of left ventricular diastolic dysfunction.
2Department of Cardiology, Faculty of Medicine, Kafkas University; Kars-Turkey
3Department of Cardiology, Erzurum Regional Training and Research Hospital; Erzurum-Turkey
4Department of Cardiology, Gaziemir State Hospital; İzmir-Turkey
5Department of Radiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon-Turkey
Amaç: Ambulatuvar arteriyel sertlik indeksi arteriyel sertlik için bir belirteç olarak öne sürülmüştür. Bu çalışmada daha önce kardiyovasküler hastalık öyküsü olmayan hipertansif diyabetik hastalarda artan ambulatuvar arteriyel sertlik indeksi' nin bozulmuş sol atriyum fonksiyonu ile ilişkili olabileceği hipotezinin araştırılması hedeflenmiştir. Yöntemler: Çalışmaya 121 hipertansif diyabetik hasta dahil edilmiştir. Tüm hastalara 24- saatlik ambulatuvar kan basıncı monitorizasyonu ve ekokardiyografi uygulanmıştır. Ambulatuvar arteriyel sertlik indeksi ve sol atriyum fonksiyonları arasındaki ilişki analiz edilmiştir. Bulgular: Tek-değişkenli analiz sonucuna göre ambulatuvar arteriyel sertlik indeksi' nin yaş (r=: 0,287, p=: 0,001), hipertansiyon süresi (r=: 0 0,388, p<0,001), açlık plazma şekeri (r=: 00,224, p: 0,014), HbA1c (r=: 0,206, p=: 0,023), LDL kolesterol (r=: 0,254, p=: 0,005), tüm-nabız basıncı (r=: 0,195, p=: 0,002), ofis-nabız basıncı (r=: 0,188, p=: 0,039), karotis intima medya kalınlığı (r=: 0,198, p=: 0,029), E/E' (r=: 0,248, p=: 0,006) ve sol atriyum volüm indeksi (r=: 0,237, p=: 0.009) ile pozitif şekilde korele olduğu gösterilmiştir. Ayrıca, ambulatuvar arteriyel sertlik indeksi'nin GFR (r=: (-) 0,242, p=: 0,008), sistolde pik sol atiyal gerginlik [S-LAs (r=: (-) 0,654, p<0,001)], erken diastolde pik sol atriyal gerginlik [S-LAe (r=: (-)0,215, p=: 0,018)] ve sistol sırasındaki sol atiyal gerginlik hızı [SR-LAs (r=: (-) 0,607, p<0,001)] ile negatif olarak korele olduğu saptanmıştır. Çok değişkenli lineer regresyon analizi ambulatuvar arteriyel sertlik indeksi'nin sistol sırasındaki sol atriyal gerginlik hızı (SR-LAs) ile bağımsız olarak ilişkili olduğunu göstermektedir (p<0,001). Sonuç: Hipertansif diyabetik hastalarda artan ambulatuvar arteriyel sertlik indeksi sol ventrikül diyastolik disfonksiyonundan bağımsız olarak bozulmuş sol atriyum fonksiyonu ile ilişkili olabilmektedir.