HİPERTANSİF HASTALARDA NABIZ BASINCI ARALIĞI İLE SOL VENTRİKÜL DİASTOLİK FONKSİYON İLİŞKİSİ

Year 2015, Volume: 5 Issue: 2, 24 - 30, 01.06.2015

Hüseyin Ede , Mehmet Ali Derya İsa Ardahanlı Onur Akgün Ali Rıza Erbay

Abstract

Amaç: Bu çalışmanın amacı, hipertansiyonu olan hastalarda nabız basıncı indeksi ile doku doppler görüntüle-
me ile ölçülen sol ventrikül diyastolik fonksiyonlar arasındaki ilişkiyi ölçmektir.
Gereç ve Yöntemler: Hipertansiyon dışında hastalığı olmayan 18 ile 55 yaş arası 75 hasta çalışmaya dahil
edildi. Yazılı kılavuzlara uygun olarak kan basıncı ölçümleri ve ekokardiyografik incelemeler yapıldı. E/A ora-
nı>1, Em>8 cm/s, Em/Am >1 veya E/Em <8 olması normal diyastolik fonksiyon olarak tanımlandı.
Bulgular: Çalışmaya 26 erkek ve 49 kadın hasta dahil edildi. Ortalama yaş 47±6 yıldı. Ortalama sistolik ve di-
yastolik kan basınçları sırasıyla 133±15 ve 83±6 mmHg idi. Vakaların %52’si (n=39) normal diyastolik fonksiyona
sahipken 32 hastada evre I, 4 hastada da evre II diyastolik disfonksiyon mevcuttu. Normal diyastolik fonksiyonu olan hastalarla karşılaştırıldığında, diyastolik disfonksiyonu olan hastalar istatistiksel olarak daha yüksek sistolik ve diyastolik kan basıncı, daha yüksek nabız basıncı ve nabız basıncı indeksine sahipti.
Sonuç: Bu çalışmada, artmış nabız basıncı indeksinin, anlamlı biçimde artmış E/Em ve sol ventrikül diyastolik
disfonksiyonu ile ilişkili olduğu göstermiştir.

Anahtar kelimeler: Diyastolik fonksiyon, Ekokardiyografi, Hipertansiyon, Nabız basıncı indeksi

ABSTRACT
Introduction: The aim of this study was to investigate association between pulse pressure index (PPI) and left
ventricular diastolic function measured via tissue Doppler imaging in hypertensive patients.
Material and Methods: Seventy five 18 to 55 years old otherwise normal patients with hypertension
were included in the study. Blood pressure measurement, echocardiographic examination were carried out
according to the published guidelines. Normal diastolic function was defined as E/A ratio >1, Em>8 cm/s, Em/ Am >1 or E/Em <8.
Results: There were 26 men and 49 women in the study population with average age of 47±6 years. Average
systolic and diastolic blood pressures were 133±15 mmhg and 83±6 mmhg respectively. 52% of the subjects
(n=39) had normal diastolic function, 32 patients had grade I diastolic dysfunction and 4 patients had psuedonormal pattern. Patients with diastolic dysfunction had significantly higher systolic and diastolic blood pressure, pulse pressure, and PPI values compared to patients with normal diastolic function.
Conclusion: This study showed that elevated PPI significantly correlates with increased E/Em and left
ventricular diastolic dysfunction in hypertensive patients.

Key words: Diastolic Function, Echocardiography, Hypertension, Pulse pressure index

Keywords

Diyastolik fonksiyon, Ekokardiyografi, Hipertansiyon, Nabız basıncı indeksi

References

• James PA, Oparil S, Carter BL, Cushman WC, Dennison- Himmelfarb C, Handler J, et al.2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).JAMA. 2014;311(5):507-20.
• Galderisi M. Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects. Cardiovasc Ultrasound. 2005;3(1):9.
• Chirayil N, Bassi N, Ramakrishna S, Beussink L, Misener S, Kane B, et al. Ultrastructural and cellular basis for the development of abnormal myocardial mechanics during the transition from hypertension to heart failure. Am J Physiol Heart Circ Physiol. 2014;306(1):H88-100.
• Paultre F, Mosca L. Association of blood pressure indices and stroke mortality in isolated systolic hypertension. Stroke. 2005;36(6):1288–90.
• Kostis JB, Lawrence-Nelson J, Ranjan R, Wilson AC, Kostis WJ, Lacy CR. Association of increased pulse pressure with the development of heart failure in SHEP. Am J Hypertens. 2001;14(8 Pt 1):798–803.
• Aparicio LS, Thijs L, Asayama K, Barochiner J, Boggia J, Gu YM, et al. Reference frame for home pulse pressure based on cardiovascular risk in 6470 subjects from 5 populations. Hypertens Res. 2014;37(7):672-8. 7. Giudici
• F, Qian Y, O’Rourke M, Avolio A. Simulation of reduction of proximal aortic stiffness by an elastic wrap and effects on pulse pressure.Conf Proc IEEE Eng Med Biol Soc. 2012;2012(1):657-60.
• Peng-Lin Y, Yue-Chun L. Pulse pressure index (pulse pressure/systolic pressure) may be better than pulse pressure for assessment of cardiovascular outcomes.Med Hypotheses. 2009;72(6):729-31.
• Lee WH, Hsu PC, Chu CY, Chen SC, Su HM, Lin TH, et al.Associations of pulse pressure index with left ventricular filling pressure and diastolic dysfunction in patients with chronic kidney disease.Am J Hypertens. 2014;27(3):454-9.
• Liao J, Farmer J. Arterial stiffness as a risk factor for coronary artery disease.Curr Atheroscler Rep. 2014;16(2):387.
• Ede H, Akgün G, Polat C.Comparison of Left Ventricular Tissue Doppler Imaging Values and Elastic Properties of the Aorta in Patients with Systemic Arterial Hypertension.Bozok Med J. 2015;4(1):1-7.
• Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction.J Am Coll Cardiol. 2014;63(5):407-16.
• Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL, et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation. 2001;104(7):779–82.
• Oishi Y, Miyoshi H, Iuchi A, Nagase N, Ara N, Oki T. Negative impact of cardiovascular risk factors on left atrial and left ventricular function related to aortic stiffness- -new application of 2-dimensional speckle-tracking echocardiography. Circ J. 2013;77(6):1490-8.