Heart pathology in patients with arterial hypertension and metabolic syndrome
Abstract
Aim: To study the specifics of heart pathology in patients with Stage I-III arterial hypertension (AH) and present or absent metabolic syndrome (MS).
Material and methods: The study included 303 patients with Stage I-III AH and MS, aged 25-70 years (mean age 52±18 years); 110 men and 193 women. All patients were divided into 2 groups (AH+MS and AH-MS) by MS presence or absence, respectively. The groups were comparable by sex and age distribution. Each group was also divided into three subgroups by AH stage (I-III). Left ventricular (LV) diastolic dysfunction (DD) was assessed by transmitral flow dopplerography (TFD), pulmonary vein dopplerography (PVD), and impulse-wave myocardial tissue dopplerography (MTD).
Results: In patients with AH and MS, LV myocardial mass increase and LV remodelling were observed at earlier AH stage, comparing to MS-free hypertensive patients. MTD demonstrated early LV diastolic dysfunction in 85 % and 88 % of the Stage I and Stage II AH patients, respectively. For TFD method, these figures were 33 % and 44 %, respectively.
Conclusion. The combination of MS and Stage I-III AH, comparing to AH only, was characterized by more severe LV diastolic dysfunction and LV remodelling at early stages of the disease.
About the Authors
G. Kh. Sharipova
Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow
Russian Federation
Russian Federation
D. M. Ataullakhanova
Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow
Russian Federation
Russian Federation
V. B. Mychka
Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow
Russian Federation
Russian Federation
M. A. Saidova
Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow
Russian Federation
Russian Federation
I. E. Chazova
Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow
Russian Federation
Russian Federation
References
1. World Health Organization -International Society of Hypertension. Guidelines for the Management of Hypertension 1999; 17(2), 151-183; 30 (Suppl.2) 1-7.
2. Чазова И.Е, Мычка В.Б. Метаболический синдром. Москва 2004.
3. Fontaine K.R, Ceskin L J.Barofsky I Health-related quality of life in obese persons seeking treatment. J Fam Pract 1996; 43: 265-70.
4. Stamler J Epidemic obesity in the United States. Arch Intern Med 1998; 150: 1040-4.
5. Kannel WB, Vasan RS, Levy D. Is the Relation of Systolic Blood Pressure to Risk of cardiovascular Disease Continuous and Graded, or Are There Critical Values? Hypertension 2003; 42(4): 453-6.
6. Bonaduce D, Breglio R, Conforti G, etal. Myocardialhypertrophy and left ventricular diastolic function in hypertensive patients: an echo Doppler evaluation. Eur Heart J 1989; 10(7): 611-21.
7. Verdecchia P, Schillaci G, Guerrieri M, et al. Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population. Eur Heart J 1990; 11: 679-91.
8. Aeschbacher BC, Hutter D, Fuhrer J, etal. Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension. Am J Hypertens 2001; 14: 106-13.
9. Molinero E, Murga N, Sagastagoitia JD. Treatment of diastolic dysfunction in hypertentensive patients without left ventricular hypertrophy. J Human Hypertens 1998; 12: 21-7.
10. Диагностика и лечение метаболического синдрома. Рекомендации ВНОК. Москва 2007.
11. Диденко В.А., СимоновД.В. Особенности гипертонического сердца при артериальной гипертонии, сочетающейся с синдромом инсулинорезистентности. Клин мед 1999; 6: 28-32.
12. Вигдорчик В.И., Прокопенко В.Д., Симонов Д.В. Диастолическая функция левого желудочка сердца у больных артериальной гипертензией, ассоциированной с метаболическим синдромом. Вест новых мед технол 2004; 11: 57-9.
13. Барац С.С., Закроева А.Г.Диастолическая функция по показателям трансмитрального кровотока и потока в легочных венах: дискуссионные вопросы патогенеза, терминологии и классификации. Кардиология 1998; 5: 69-76.
14. Профилактика, диагностикаилечение артериальной гипертензии. Российские рекомендации (второй пересмотр). Москва 2004.
15. Саидова М.А, Сергакова Л.М., Атауллаханова Д.М. и др. Современные эхокардиографические подходы к оценке гипертрофии миокарда и структурного состояния левого желудочка у больных артериальной гипертонией. Метод пособие для врачей. Москва 2007.
16. Recommendations for Chamber Quantification: A Report from the American Society of echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with tReche European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1446-7.
17. Shirai T, Kasao M, Nozaki M, et al. Evaluation of hypertensive cardiac abnormalitie sing the Cornell product. Circulation 2007; 71: 731-5.
18. Nagueh SF, Middleton KJ, Kopelen HA, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. JACC 1997; 30: 1527-33.
19. Appleton CA, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. JACC 1988; 12: 426-40.
20. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. JACC 1997; 30: 474-80.
21. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345-52.
22. Конради А.О., Жукова А.В., Винник Т.А., Шляхто Е.В. Структурно-функциональные параметры миокарда у больных гипертонической болезнью в зависимости от массы тела, типа ожирения и состояния углеводного обмена. Артер гиперт 2002; 8(1): 12-7.
23. Зимин Ю.В., Родоманченко Т.В., Бойко Т.А., Федосеева А.В. Клиническая и гемодинамическая характеристика гипертонической болезни, ассоциированной с инсулинорезистентностью, связь массы миокарда ЛЖ сердца с гиперсекрецией инсулина. Кардиология 1998; 4: 9-13.
24. Овчинников А.Г. Ожирение и сердечно-сосудистая система. Сердце 2005; 4(5): 243-53.
25. Reaven G.M. Insulin resistence/ compensatory hyperinsulinemia. Essential hypertension and cardiovascular disease J Clin Endocrinol Metab 2003; 88(6): 2399-403.
26. Мuiesan MC, Salvetti M, Monteduro Gristina,et al. LV Concentric Geometry During TreatmentAdversely Cardiovascular Prognosis in HypertensivePatients. Hypertension 2004; 43: 731-8.
27. Di Tullio MR, Zvas DR, Sacco DD, et al. Left Ventricular Mass and Geometry Risk of Ischemic Stroke. Stroke 2003; 34: 2380-9.
28. Palatini P, Visentin P, Mormino P, et al. Results from Hypertension and Ambulatory Recording Venetia Study (HARVEST) Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. Am J Hypertens 1998; 11: 147-54.
29. Ferara L. Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study. J Hum Hypertens 2007; 21(10): 795-801.
30. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assesmaent of left ventricular hypertophy: comparison to necropsy finding. Am J Cardiol 1986; 57: 450-8.
31. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertophy and geometric remodeling in essential hypertension. JACC 1992; 19: 1550-8.
Review
For citations:
Sharipova G.Kh., Ataullakhanova D.M., Mychka V.B., Saidova M.A., Chazova I.E. Heart pathology in patients with arterial hypertension and metabolic syndrome. Cardiovascular Therapy and Prevention. 2008;7(8):20-26. (In Russ.)
Views:
1184
Email this article 
