Hipertansiyonlu hastalarda sol ventrikülün eş zamanlı kasılmasını etkileyen faktörler: Arteriyel katılık ve merkezi kan basıncı etkili mi?

Amaç: Sol ventrikül (SV) eş zamanlı kasılma bozukluğu hipertansiyonlu hastalarda sık rastlanılan bir bulgu olup SV hipertrofisi ile ilişkilidir. Arteriyel katılık (AK) ve merkezi (aortik) kan basıncı, SV hipertrofisi gibi hipertansiyon kaynaklı hedef organ hasarında önemli rol oynar. Bu çalışmada, AK, merkezi sistolik ve diyastolik kan basınçları (KB) ve SV senkronizasyon bozukluğu arasındaki ilişki incelendi. Çalışma planı: Yeni hipertansiyon tanısı konmuş 35 hasta ve 40 kontrol çalışmaya alındı. Tüm çalışma popülasyonuna ‘doku senkronizasyon görüntülemesini’ (DSG) de içeren kapsamlı ekokardiyografik inceleme yapıldı. SV’nin pik sistolik doku hız zamanı (Zs) 12 segment modeli ile ölçüldü ve iki eş zamanlı kasılma bozukluğu indeksi hesaplandı. Nabız dalga hızı (NDH) ve artış indeksini (AIx@75) içeren AK parametreleri ile merkezil sistolik ve diyastolik KB aplanasyon tonometresi ile değerlendirildi. Bulgular: Kan basınçları dışında her iki grubun temel klinik ve ekokardiyografik parametreleri benzerdi. Eş zamanlı kasılma bozukluğu indeksleri hipertansiyonlu hastalarda kontrol grubuna göre uzamıştı: 12 segmentin Zs’nın standart sapması (48.7±18.8 ve 25.8±13.1, p<0.001); herhangi iki segmentin maksimum Zs farkı (143.9±52.2 ve 83.8±39.4, p<0.001), NDH (11.9±2.5 ve 9.5±1.4, p<0.001), AIx@75 (27.4±8.3 ve 18.3±9, p=0.009), merkezi sistolik (147.6±20.8 ve 105.4±11, p<0.001) ve diyastolik (99.8±14.4 ve 72.8±9.5, p<0.001) basınçlar hipertansiyonlu hastalarda kontrol grubundan daha yüksekti. Çok değişkenli analizde, merkezi sistolik KB (?=0.496, p=0.03), SV kitle indeksi (?=0.232, p=0.027) ve beden kütle indeksi (?=0.308, p=0.002) eş zamanlı kasılma bozukluğu ile bağımsız ilişkili bulundu. Sonuç: Merkezi sistolik KB, yeni tanı konmuş hipertansiyonlu hastalarda SV’nin eş zamanlı kasılma bozukluğunun bağımsız öngördürücüsüdür. Ancak AIx@75, SV eş zamanlı kasılması üzerinde doğrudan etkiye sahip değildir.Objectives: Left ventricular (LV) dyssynchrony is a common finding in patients with hypertension and is associated with LV hypertrophy. Arterial stiffness (AS) and central (aortic) blood pressures play a significant role in end-organ damage such as LV hypertrophy caused by hypertension. The objective of this study was to investigate the relationship between AS, central blood pressures (BP) and LV dyssynchrony. Study design: Thirty-five newly diagnosed hypertensive patients and 40 controls were enrolled in the study. The entire study population underwent a comprehensive echocardiographic study including tissue synchrony imaging. The 12 segmental model was used to measure the time to regional peak systolic tissue velocity (Ts) in the LV and two dyssynchrony indices were computed. Parameters of AS including pulse wave velocity (PWV), augmentation index (AIx@75), and central systolic and diastolic BP were evaluated by applanation tonometry. Results: The baseline clinical and echocardiographic parameters of both groups were similar except for their BPs. Dyssynchrony indices were prolonged in patients with hypertension as compared to the controls. The standart deviation of Ts of 12 LV segments in patients with hypertension and the controls were 48.7±18.8 vs. 25.8±13.1, respectively (p<0.001), and the maximal difference in Ts between any 2 of 12 LV segments was 143.9±52.2 for hypertension patients vs. 83.8±39.4 for controls (p<0.001). PWV (11.9±2.5 vs. 9.5±1.4, p<0.001), AIx@75 (27.4±8.3 vs. 18.3±9, p=0.009), and central systolic (147.6±20.8 vs. 105.4±11, p<0.001) and diastolic (99.8±14.4 vs. 72.8±9.5, p<0.001) pressures were higher in patients with hypertension than in the controls, respectively. In multivariable analysis, central systolic BP (?=0.496, p=0.03), LV mass index (?=0.232, p=0.027), and body mass index (?=0.308, p=0.002) were found to be independently related to dyssynchrony. Conclusion: Central systolic BP is an independent predictor of LV dyssynchrony, but AIx@75 did not have an independent effect on LV synchronicity in patients with newly-diagnosed hypertension

Zależność między grubością nasierdziowej tkanki tłuszczowej a występowaniem częstych przedwczesnych pobudzeń komorowych

Background: Ventricular premature beats (VPBs) are one of the most common rhythm abnormalities. Structural heart diseases such as myocardial hypertrophy and left ventricular dysfunction are associated with VPBs. However, the exact mechanism of VPBs in patients without structural heart disease has not been revealed yet. Epicardial fat tissue (EFT) is a visceral fat around the heart. Increased EFT thickness is associated with myocardial structural and ultrastructural myocardial abnormalities, which may play a role in the development of VPBs. Aims: To evaluate the possible relationship between EFT thickness and frequent VPBs. Methods and results: The study population consisted of 50 patients with VPBs and 50 control subjects. Frequent VPBs were defined as the presence of more than 10 beats per hour assessed by 24-h Holter electrocardiography monitoring. EFT thickness was measured by transthoracic echocardiography. Multivariable logistic regression analysis was used to assess factors related with frequent VPBs. Baseline demographic and biochemical features including age, gender, and rates of hypertension and diabetes mellitus were similar in both groups. EFT thickness was significantly higher in patients with frequent VPBs than in controls (3.3 ± 1.3 mm vs. 2.2 ± 0.8 mm, p &lt; 0.001). In multivariable logistic regression analysis, EFT thickness was independently associated with VPB frequency (B = 1.030, OR = 2.802, p &lt; 0.001). Conclusions: Patients with frequent VPBs had increased EFT thickness compared to control subjects. EFT thickness was independently associated with frequent VPBs.Wstęp: Pobudzenia przedwczesne komorowe (VPB) to jedne z najczęstszych zaburzeń rytmu. Choroby strukturalne serca, takie jak przerost mięśnia sercowego i dysfunkcja lewej komory, wiążą się z VPB. Jednak dotychczas nie wyjaśniono dokładnie mechanizmu powodującego VPB u pacjentów bez strukturalnej choroby serca. Nasierdziowa tkanka tłuszczowa (EFT) jest zlokalizowana wokół serca, a jej zwiększona grubość wiąże się z występowaniem strukturalnych i ultrastrukturalnych zaburzeń mięśnia sercowego, które mogą przyczyniać się do rozwoju VPB. Cel: Badanie przeprowadzono w celu oceny możliwych zależności między grubością EFT a częstymi VPB. Metody i wyniki: Badana populacja składała się z 50 chorych z VPB i 50 osób stanowiących grupę kontrolną. Częste VPB definiowano jako obecność ponad 10 pobudzeń na godzinę ocenianych w całodobowym monitorowaniu elektrokardiograficznym metodą Holtera. Grubość EFT mierzono w echokardiografii przezklatkowej. Do oceny czynników związanych z częstymi VPB zastosowano wielozmiennową analizę regresji logistycznej. Wyjściowe dane demograficzne i biochemiczne, w tym wiek, płeć, odsetek osób z nadciśnieniem tętniczym i cukrzycą, były podobne w obu grupach. Grubość EFT była istotnie większa u chorych z częstymi VPB niż u osób z grupy kontrolnej (3,3 ± 1,3 mm vs. 2,2 ± 0,8 mm; p &lt; 0,001). W wielozmiennowej analizie regresji logistycznej wykazano, że grubość EFT była niezależnie związana z częstością VPB (B = 1,030; OR = 2,802; p &lt; 0,001). Wnioski: U chorych z VPB grubość EFT była większa niż u osób z grupy kontrolnej. Grubość EFT była niezależnie związana z częstymi VPB