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Association of carotid and left ventricular stucture in a middle-aged general population
AIR-APRIL 1996-VOL. 9, NO.4, PART 2
64A ASH XI ABSTRACTS
137
138
TIlE RELATIONSHIP BETWEEN HYPERTENSION GEOMETRIC AND MECHANIC EFFECTS. J Diego EsPInosa, R.L.Armenlano,G.Casanave, H.Baglivo, R.Ptchel and Sanchez R. BasIC Research Center, University Institute of Biomedical Sciences. Favaloro Foundation, Buenos Aires, Argentina The blood pressure and the diameter alterations ofthe large arteries are the most hypertensive well-know effects. These effects mcrease reflection coeffiCIent (D and the pulse wave velocity (PWV). The mismatch index (MI) depend on these two effects and this double negatIve effect deteriorates the left ventricule The aim of the present study was to determinate the relationship between hypertension geometric and mechanic effects Methods: the mean arterial pressure (MAP. mmHg, Dinamap, CrilJkon, Tampa, Flonda). the mean braclual artery dIameter (MD, mm. Echocardiogrphy Hewlett-Packard Sono l5(0)and the mean flow (MF, mUs, strain gauge plethysmographic method) were mvestigated in 12 (36±1I years) women normotenslves (NTA. MAP=85±9, MF=2.06±O.67) and 15 (50%9 years) essentIal hypertenslves(HTA, MAP 107"10", MF 2.20%0.90). Pulse wave velocity (PWV) was calculated from simultaneous carotid and radial artenal pressure recordIngs with two strain gauge mechanography transducers positioned simultaneously at the level of carotid and radIal artenes.The penpheral resistance was calculated as Rp=MPIMF, and characteristic resiStance as Rc=d PWV/(ll /4 M02), where li is the blood denSIty, and r=Rc.RpIR(:+Rp We defined the rmsmatch multiplying PWV by r.Results· MD, Rp, WPV, r toNTA" 005 "". 001 andMI weremcreasedmHTA res MD R WPV MI NTA 0 31±O 05 667"1 347 8 62±O 98 545"1 15 HTA 0 35±O 07" 734"1 15" 11"2 12" 070±0 10" 730%1 52" MAP and MD were the only parameters that correlated WIth MI (r=O.86") Conclusion' geometric and mechanic effects are the most responsible of the increase of the MI. Dunng hypertenSion the arterial diameter alteralJon and peripheral vasoconstntlon mcrease the reflcted wave The hIgh blood pressure mcreases the PWV through the stiffness on the parietal artery.
MAGNETIC RESONANCE IMAGING ARTERIOGRAPHY (MRIA) OF CONDUIT ARTERIES. ~, OH Jones, GP Forsyth aod RJ Bruce. Circulatory Disease Cenler, SI. Joseph Hospital, Augusta, GA Hypertensivcs often require evaluation aod management for corrective conduit artery obstructions due to atherosclerosis among artenes other than the epicardial coronaries AIheroIclerosis of the extracranial carotids, the \'efIcbral-btsi1ar arteries aod the intracranial cerebral arteries, WIth and without neurological symptoms, occurs at a much htgbcr incidence among h)-pertel1llves as compared to those with normal blood pressures. Tbc use of Bmode and Duplex ultrasound scanning enhances the detection of atherosclerosis and the degree of stenosl& among the above conduit arteries in hypertensives When possible cornctable obstruction of >60% occurs with or without syrnptOntl an attempt at corrccllon of the obstruction is mdicated to prevent sttoItca Assessment of total extra aod intrll
Key Words: artena I comp I'lance. vascu Iar Impedance. wave rctlectlon .
139
140
ASSOCIATION OF CAROTID AND LEFT VENTRJCULAR STRUCTURE IN A MIDDLE-AGED GENERAL POPULATION M L Muiesan, M Salvetti, S Calebich, R Zulli, M Castellano", D Rizzoni", G Belloni, A Cinelli, E Porten, GF Pasiru,E Agablti-Rosei ". Cattedra dl Semeiotica e Metodologia MedIca, University' of BreSCIa. The objective of this study was to determine common carotid intima-media (1M) thickness and cross-sectional area (CSA), taken as indeces of structural alterations, as related to left ventricular geometric patterns, in a middle-aged general population, living in a small town of Northern Italy (Vobamo, Brescia). In 225 untreated subjects (107 F, 118 M, age range 4864 years) 1M thickness of common carotid (CCl, as well as the presence of atherosclerotic leSIOns were evaluated by ultrasound (HP Sonos 1(00). Subjects were divided in 3 groups, accordmg to the presence of LVH (LVMI>134 gimZ m M and 1I0gimz in F) or LVremodeling (relatIve wall thickness > 0 45). Results are as shown: "= ANOVA P > 0.5 Normals LV LVH remodeling Ageyn 57± 5 58 ±3 57 ±4 Ses(M/F) 86/88 8/6 24113 24 hn MAP nunHg 91.H79 94 ± 9 901±82 Clinic SAP rranIl& 138±15 136±15 143 ± 13 Clinic DAP nunHg 85±8 87±7 86±8 CC 1M thickness 0.71±O 2 0.69±O 18 o 82±O 32"
POWER SPECTRAL ANAl.YSIS OF HEART RATE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT lEFT VENTRICULAR HYPERTROPHY. THE EFFECT OF LEFT VENTRICULAR MASS REDUCTION. Ml MUlesan, D RJzzonI', R Zulli, MCasleliano',G Beltoni, E Porteri, E Agablb-Rosei, MD caUecta d Semeiotica 8 MeloOOlogla Medca, UnMll'Slty of Brescia, Italy Power spectral analysis (PSA) 01 heart rate may prtMde usef~ infonnations about cardac autonomic nerwua system actiVIty Aim oIlhis studt was 10 evaluate PSA 01 heart rate in nonnotensiw 8ItlIects and In hypertensive pabents WlIh and Wllhoulleft ventncular hypertrq:lhy (lVH), in basal conditions and after reversal oIlVH IndIced by effective longtenn antihypertensive treatment In 5 male nonnotensive 8ItlIects and in 17 hypertenSIves (10 With and 7 WllhoullVH) a 24 holx EKG Holter monltonng (Del Mar AVIonICS) and an echo assessment were performed Sequences of 512 R-R intelVals, cooespondng 10 daybme (lQ..tt am), afternoon (4-5 pm.) and ntghl-bme (Q..2 am) penods, <1Jnng Which patients remallled Sl4llne In bed, were taken lor !he evaluation of PSA (Box-Jenkins method) M>soIute and nonnahsed (over tolal v8I1ance) power spectral denSIty 01 !he peak at 0 10 Hz (low ~ peak IF) and al 0 25 Hz (high f~ peak HF) were calculated Adaybme to night-time decrease of IF was detected In normoterlSlve 8ItlIects (p
nun
CC CSA ....' 143±3.8 144±5 I 163±6 " Logis\lc regressIon analysis, mcluding traditIOnal nsk factors and 24 hours monitored BP, showed that the presence of LVH was associated to a grealer IMT (p = 0 02), while the presence or LV remodeling was assoctaled to a greater body mass index (p = 0 05) In conclusion, m a general population, the presence of LVH , but not of LV remodeling, is related to increased 1M thickness
Key Words: ventricular hyperuophy.
Carotid intama-media thickness. Left
KeyWordS "'Il'e&8lOn
spectral analysis of heart rate, l VH
64A ASH XI ABSTRACTS
137
138
TIlE RELATIONSHIP BETWEEN HYPERTENSION GEOMETRIC AND MECHANIC EFFECTS. J Diego EsPInosa, R.L.Armenlano,G.Casanave, H.Baglivo, R.Ptchel and Sanchez R. BasIC Research Center, University Institute of Biomedical Sciences. Favaloro Foundation, Buenos Aires, Argentina The blood pressure and the diameter alterations ofthe large arteries are the most hypertensive well-know effects. These effects mcrease reflection coeffiCIent (D and the pulse wave velocity (PWV). The mismatch index (MI) depend on these two effects and this double negatIve effect deteriorates the left ventricule The aim of the present study was to determinate the relationship between hypertension geometric and mechanic effects Methods: the mean arterial pressure (MAP. mmHg, Dinamap, CrilJkon, Tampa, Flonda). the mean braclual artery dIameter (MD, mm. Echocardiogrphy Hewlett-Packard Sono l5(0)and the mean flow (MF, mUs, strain gauge plethysmographic method) were mvestigated in 12 (36±1I years) women normotenslves (NTA. MAP=85±9, MF=2.06±O.67) and 15 (50%9 years) essentIal hypertenslves(HTA, MAP 107"10", MF 2.20%0.90). Pulse wave velocity (PWV) was calculated from simultaneous carotid and radial artenal pressure recordIngs with two strain gauge mechanography transducers positioned simultaneously at the level of carotid and radIal artenes.The penpheral resistance was calculated as Rp=MPIMF, and characteristic resiStance as Rc=d PWV/(ll /4 M02), where li is the blood denSIty, and r=Rc.RpIR(:+Rp We defined the rmsmatch multiplying PWV by r.Results· MD, Rp, WPV, r toNTA" 005 "". 001 andMI weremcreasedmHTA res MD R WPV MI NTA 0 31±O 05 667"1 347 8 62±O 98 545"1 15 HTA 0 35±O 07" 734"1 15" 11"2 12" 070±0 10" 730%1 52" MAP and MD were the only parameters that correlated WIth MI (r=O.86") Conclusion' geometric and mechanic effects are the most responsible of the increase of the MI. Dunng hypertenSion the arterial diameter alteralJon and peripheral vasoconstntlon mcrease the reflcted wave The hIgh blood pressure mcreases the PWV through the stiffness on the parietal artery.
MAGNETIC RESONANCE IMAGING ARTERIOGRAPHY (MRIA) OF CONDUIT ARTERIES. ~, OH Jones, GP Forsyth aod RJ Bruce. Circulatory Disease Cenler, SI. Joseph Hospital, Augusta, GA Hypertensivcs often require evaluation aod management for corrective conduit artery obstructions due to atherosclerosis among artenes other than the epicardial coronaries AIheroIclerosis of the extracranial carotids, the \'efIcbral-btsi1ar arteries aod the intracranial cerebral arteries, WIth and without neurological symptoms, occurs at a much htgbcr incidence among h)-pertel1llves as compared to those with normal blood pressures. Tbc use of Bmode and Duplex ultrasound scanning enhances the detection of atherosclerosis and the degree of stenosl& among the above conduit arteries in hypertensives When possible cornctable obstruction of >60% occurs with or without syrnptOntl an attempt at corrccllon of the obstruction is mdicated to prevent sttoItca Assessment of total extra aod intrll
Key Words: artena I comp I'lance. vascu Iar Impedance. wave rctlectlon .
139
140
ASSOCIATION OF CAROTID AND LEFT VENTRJCULAR STRUCTURE IN A MIDDLE-AGED GENERAL POPULATION M L Muiesan, M Salvetti, S Calebich, R Zulli, M Castellano", D Rizzoni", G Belloni, A Cinelli, E Porten, GF Pasiru,E Agablti-Rosei ". Cattedra dl Semeiotica e Metodologia MedIca, University' of BreSCIa. The objective of this study was to determine common carotid intima-media (1M) thickness and cross-sectional area (CSA), taken as indeces of structural alterations, as related to left ventricular geometric patterns, in a middle-aged general population, living in a small town of Northern Italy (Vobamo, Brescia). In 225 untreated subjects (107 F, 118 M, age range 4864 years) 1M thickness of common carotid (CCl, as well as the presence of atherosclerotic leSIOns were evaluated by ultrasound (HP Sonos 1(00). Subjects were divided in 3 groups, accordmg to the presence of LVH (LVMI>134 gimZ m M and 1I0gimz in F) or LVremodeling (relatIve wall thickness > 0 45). Results are as shown: "= ANOVA P > 0.5 Normals LV LVH remodeling Ageyn 57± 5 58 ±3 57 ±4 Ses(M/F) 86/88 8/6 24113 24 hn MAP nunHg 91.H79 94 ± 9 901±82 Clinic SAP rranIl& 138±15 136±15 143 ± 13 Clinic DAP nunHg 85±8 87±7 86±8 CC 1M thickness 0.71±O 2 0.69±O 18 o 82±O 32"
POWER SPECTRAL ANAl.YSIS OF HEART RATE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT lEFT VENTRICULAR HYPERTROPHY. THE EFFECT OF LEFT VENTRICULAR MASS REDUCTION. Ml MUlesan, D RJzzonI', R Zulli, MCasleliano',G Beltoni, E Porteri, E Agablb-Rosei, MD caUecta d Semeiotica 8 MeloOOlogla Medca, UnMll'Slty of Brescia, Italy Power spectral analysis (PSA) 01 heart rate may prtMde usef~ infonnations about cardac autonomic nerwua system actiVIty Aim oIlhis studt was 10 evaluate PSA 01 heart rate in nonnotensiw 8ItlIects and In hypertensive pabents WlIh and Wllhoulleft ventncular hypertrq:lhy (lVH), in basal conditions and after reversal oIlVH IndIced by effective longtenn antihypertensive treatment In 5 male nonnotensive 8ItlIects and in 17 hypertenSIves (10 With and 7 WllhoullVH) a 24 holx EKG Holter monltonng (Del Mar AVIonICS) and an echo assessment were performed Sequences of 512 R-R intelVals, cooespondng 10 daybme (lQ..tt am), afternoon (4-5 pm.) and ntghl-bme (Q..2 am) penods, <1Jnng Which patients remallled Sl4llne In bed, were taken lor !he evaluation of PSA (Box-Jenkins method) M>soIute and nonnahsed (over tolal v8I1ance) power spectral denSIty 01 !he peak at 0 10 Hz (low ~ peak IF) and al 0 25 Hz (high f~ peak HF) were calculated Adaybme to night-time decrease of IF was detected In normoterlSlve 8ItlIects (p
nun
CC CSA ....' 143±3.8 144±5 I 163±6 " Logis\lc regressIon analysis, mcluding traditIOnal nsk factors and 24 hours monitored BP, showed that the presence of LVH was associated to a grealer IMT (p = 0 02), while the presence or LV remodeling was assoctaled to a greater body mass index (p = 0 05) In conclusion, m a general population, the presence of LVH , but not of LV remodeling, is related to increased 1M thickness
Key Words: ventricular hyperuophy.
Carotid intama-media thickness. Left
KeyWordS "'Il'e&8lOn
spectral analysis of heart rate, l VH