cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1485Research ArticleРАЗНОЕСтруктурно-функциональное состояние сосудистой стенки у больных ишемической болезнью сердца, артериальной гипертонией и их сочетаниемVascular wall structure and function in patients with CHD, AH, and their combinationФедуловВ. К.FedulovV. K.

аспирант отдела ангиологии

Москва, Тел.: 8 903 805 99 99

Fedylov82@mail.ruСоболеваГ. Н.SobolevaG. N.

в.н.с. отдела ангиологии

Москва

РогозаА. Н.RogozaA. N.

руководитель отдела новых методов диагностики

Москва

БалахоноваТ. В.BalakhonovaT. V.

профессор отдела новых методов диагностики

Москва

ТрипотеньМ. И.TripotenM. I.

н.с. отдела новых методов диагностики

Москва

КарповЮ. А.KarpovYu. A.

руководитель отдела ангиологии

Москва

Институт клинической кардиологии им. А.Л. Мясникова ФГУ РКНПКA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex2011200220111017379Copyright © Федулов В.К., Соболева Г.Н., Рогоза А.Н., Балахонова Т.В., Трипотень М.И., Карпов Ю.А., 20112011Федулов В.К., Соболева Г.Н., Рогоза А.Н., Балахонова Т.В., Трипотень М.И., Карпов Ю.А.Fedulov V.K., Soboleva G.N., Rogoza A.N., Balakhonova T.V., Tripoten M.I., Karpov Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1485

Цель. Оценить структурно-функциональные изменения сосудистой стенки у больных ишемической болезнью сердца (ИБС), артериальной гипертонией (АГ) и их сочетанием. Материал и методы. Обследованы 3 группы (гр.) пациентов (n=120): в I гр. – 34 пациента с ИБС, средний возраст 57,3±10,4 лет (76 % мужчин, 54 % курящих); во II гр. — 46 пациентов с ИБС+АГ, средний возраст 62,4±6,5 лет (41 % мужчин, курящих 15 %); в III гр. — 40 пациентов с АГ, средний возраст 56,8±9,2 лет (68 % мужчин, 30 % курящих). Структурные изменения общей сонной артерии (ОСА) оценивали с помощью измерения толщины “интима-медии” (ТИМ). Для оценки скорости пульсовой волны (СПВ), индекса аугментации, использовались данные, полученные для плечевой артерии (ПА). Для оценки атеросклеротических изменений артерий нижних конечностей использовали показатель — лодыжечноплечевой индекс. Оценивали растяжимость и жесткость β ОСА. Региональную жесткость артерий оценивали определением лодыжечно-плечевой СПВ. Поток-зависимую вазодилатацию (ПЗВД) ПА определяли в пробе с реактивной гиперемией. Результаты. Увеличение ТИМ с учетом пола и возраста в большей степени выявлено в гр. ИБС+АГ (57 %), в этой же гр. отмечается наиболее низкие показатели растяжимости и высокие — локальной жесткости ОСА. Региональная жесткость с учетом пола и возраста в большей степени выражена у больных АГ (49 %) и в гр. ИБС+АГ (43 %). Заключение. Гр. ИБС+АГ характеризуется наиболее выраженными “сосудистыми факторами риска”, ремоделированием сосудистой стенки, выраженным атеросклерозом артерий нижних конечностей, повышенной жесткостью сосудистой стеки. Однако более выраженное нарушение ПЗВД наблюдалось в гр. ИБС, с гиперлипидемией, избыточной массой тела и курением, что еще раз продемонстрировало ключевую роль “сосудистых факторов риска” в развитии дисфункции эндотелия.

Aim

Aim. To assess the changes in vascular wall structure and function among patients with coronary heart disease (CHD), arterial hypertension (AH), or CHD and AH combination.

Material and methods

Material and methods. In total, 3 groups of the patients (n=120) were examined. Group I included 34 CHD patients (mean age 57,3±10,4 years; 76% men; 54% smokers). Group II included 46 patients with CHD and AH (mean age 62,4±6,5 years; 41% men; 15% smokers). Group III included 40 AH patients (mean age 56,8±9,2 years; 68% men; 30% smokers). Common carotid artery (CCA) structure was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) and augmentation index were assessed, based on the data for brachial artery. Atherosclerotic changes in lower extremity arteries were evaluated using ankle-brachial index. Other assessed parameters included CCA distensibility and stiffness β; ankle-brachial PWV, as a marker of regional artery stiffness; and brachial artery flow-dependent vasodilatation, FDVD in reactive hyperemia test.

Results

Results. Age- and gender-adjusted IMT increase was more pronounced in patients with CHD and AH (57%). This group was characterised by the lowest values of distensibility and the highest values of local CCA stiffness. The age- and gender-adjusted levels of regional artery stiffness were higher in patients with AH (49%) and participants with CHD and AH (43%).

Conclusion

Conclusion. Patients with CHD and AH were characterised by the highest levels of vascular risk factors, vascular wall remodelling, atherosclerosis of lower extremity arteries, and increased vascular wall stiffness. FDVD was most affected in CHD patients with such risk factors as hyperlipidemia, overweight, or smoking. Therefore, vascular risk factors play a key role in endothelial dysfunction development.

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The authors declare that there are no conflicts of interest present.