Correlation Between Increased Thoracic Aortic Intima-Media Thickness and Renal Doppler Parameters in Hypertensive Patients: A Cross-Sectional Study

Abstract

Introduction: Increased vascular intima-media thickness is an accepted marker of subclinical atherosclerosis and closely correlates with cardiovascular risk factors. Hypertension is a robust risk factor for increased thoracic aortic intima-media thickness (TA-IMT) and deteriorated renal Doppler measurements. Owing to the lack of information about the correlation between TA-IMT and renal Doppler parameters, this study aims to investigate the same in hypertensive patients. Patients and Methods: This cross-sectional study examined 112 hypertensive patients who underwent transesophageal echocardiography (TEE) for different diagnostic reasons. The patients were divided into group 1 (56 patients with increased TA-IMT) and group 2 (56 patients without increased TA-IMT). For all patients, transthoracic echocardiography, TEE, renal B-mode and Doppler ultrasound, and laboratory measurements were performed. Results: Compared with group 2, group 1 had markedly elevated systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels. In addition, renal resistive index (RRI), renal pulsatility index (RPI), the presence of RRI > 0.70, and cortical thickness were markedly higher in group 1 than that in group 2. Besides, renal acceleration time (AT) was considerably lower in group 1 patients. In group 1, we observed increased RRI (> 0.70) in 39 (70%) hypertensive patients. Furthermore, linear regression analyses revealed an independent correlation of SBP, BMI, LDL cholesterol, and renal AT with TA-IMT. Conclusion: This study establishes a correlation between increased TA-IMT values and deteriorated renal Doppler measurements in hypertensive patients. Perhaps, TA-IMT measurements could help to determine the end-stage organ damage in hypertensive patients who undergo TEE.

Keywords

• Hypertension
• thoracic aortic intima-media thickness
• renal ultrasound
• Doppler

Hipertansif Hastalarda Torasik Aortik İntima Media Kalınlığı Renal Doppler Parametreleri ile İlişkilidir

Abstract

Giriş: Artmış intima media kalınlığı subklinik bir ateroskleroz belirteci olarak kabul edilmektedir ve kardiyovasküler risk faktörleri ile yakından ilişkilidir. Hipertansiyon artmış torasik aortik intima media kalınlığı (TA-IMK) ve bozulmuş renal Doppler ölçümleri için bilinen bir risk faktörüdür. Araştırdığımız kadarıyla, TAIMK ve renal Doppler parametreleri arasındaki ilişkiye dair bir bilgi yoktur. Bu çalışmanın amacı, hipertansif hastalarda böyle bir ilişki olup olmadığını incelemektir. Hastalar ve Yöntem: Kesitsel çalışmamız çeşitli sebeplerle transözefageal ekokardiyografi yapılan ve hipertansiyonu olan 112 hastayı içermektedir. Grup 1’de TA-IMK artmış 56 hasta yer almıştır. Grup 2’de ise TA-IMK normal olan 56 hasta mevcuttur. Tüm hastalara transtorasik, transözefageal ekokardiyografi, renal B-mod, Doppler ultrason ölçümleri ve standart laboratuvar incelemeleri yapılmıştır. Bulgular: Grup 1’deki hastalarda belirgin olarak artmış sistolik, diyastolik kan basınçları, beden kütle indeksi (BKİ), total ve LDL kolesterol ve trigliserid değerleri saptanmıştır. RRI, RPI değerleri, RRI > 0.70 olma sıklığı ve renal kortikal kalınlık ölçümleri grup 1’de önemli ölçüde artmıştır. Bu hastalarda renal AT belirgin biçimde azalmıştır. Artmış RRI (RRI > 0.70), grup1’deki 39 (%70) hastada görülmüştür. Lineer regresyon analizinde sistolik kan basıncı, BKİ, LDL kolesterol ve renal AT’nin TA-IMK ile bağımsız olarak ilişkili olduğu görülmüştür. Sonuç: Çalışmamızda hipertansif hastalarda artmış TA-IMK ve bozulmuş renal Doppler parametreleri arasında bir ilişki olduğu gösterilmiştir. Transözefageal ekokardiyografi yapılması düşünülen hipertansif hastalarda TA-IMK ölçümü yapılması uç organ hasarını saptamak için faydalı olabilecek gibi görünmektedir.

Keywords

• Hipertansiyon
• torasik aort
• intima media kalınlığı
• renal ultrason
• Doppler

References

1. 1. Intima-media thickness is linearly and continuously associated with systolic blood pressure in a population-based cohort (STANISLAS Cohort Study). J Am Heart Assoc 2016;5:e003529.
2. 2. Magnussen CG. Carotid artery intima-media thickness and hypertensive heart disease: a short review. Clin Hypertens 2017;23:7.
3. 3. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986;74:1399-406.
4. 4. Koc AS, Sumbul HE. Increased aortic intima-media thickness may be used to detect macrovascular complications in adult type II diabetes mellitus patients. Cardiovasc Ultrasound 2018;16:8.
5. 5. Li W, Luo S, Luo J, Liu Y, Huang W, Chen J. Association between abdominal aortic plaque and coronary artery disease. Clin Interv Aging 2016;11:683-8.
6. 6. Harrington J, Pena AS, Gent R, Hirte C, Couper J. Aortic intima media thickness is an early marker of atherosclerosis in children with type 1 diabetes mellitus. J Pediatr 2010;156:237-41.
7. 7. Viazzi F, Leoncini G, Derchi LE, Pontremoli R. Ultrasound Doppler renal resistive index: a useful tool for the management of the hypertensive patient. J Hypertens 2014;32:149-53.
8. 8. Boddi M. Renal ultrasound (and Doppler sonography) in hypertension: an update. Adv Exp Med Biol 2017;956:191-208.

9. 9. Hanamura K, Tojo A, Kinugasa S, Asaba K, Fujita T. The resistive index is a marker of renal function, pathology, prognosis, and responsiveness to steroid therapy in chronic kidney disease patients. Int J Nephrol 2012;2012:139565.
10. 10. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
11. 11. Galderisi M. Diagnosis and management of left ventricular diastolic dysfunction in the hypertensive patient. Am J Hypertens 2011;24:507-17.
12. 12. Nishino M, Masugata H, Yamada Y, Abe H, Hori M, Kamada T. Evaluation of thoracic aortic atherosclerosis by transesophageal echocardiography. Am Heart J 1994;127:336-44.
13. 13. Hong YM. Atherosclerotic cardiovascular disease beginning in childhood. Korean Circ J 2010;40:1-9.
14. 14. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-104.
15. 15. Koc AS, Gorgulu FF, Donmez Y, Icen YK. There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima-media thickness in hypertensive patients. J Med Ultrason (2001) 2018;45:597-603.
16. 16. Mensah GA. Hypertension and target organ damage: don’t believe everything you think! Ethn Dis 2016;26:275-8.
17. 17. Doi Y, Iwashima Y, Yoshihara F, Kamide K, Takata H, Fujii T, et al. Association of renal resistive index with target organ damage in essential hypertension. Am J Hypertens 2012;25:1292-8.