YENİ TANI ESANSİYEL HİPERTANSİYON HASTALARINDA PRESİSTOLİK DALGA AORTİK SERTLİK DERECESİNİ ÖNGÖRDÜREBİLMEKTE, FAKAT SİRKADİYEN KAN BASINCI PATERNİNİ ÖNGÖREMEMEKTEDİR Presystolic Wave Velocity May Predict Aortic Stiffness But Not Circadian Blood Pressure Pattern In Patients With Newly Diagnosed Essential Hypertension

Yıl 2019, Cilt: 9 Sayı: 2, 112 - 119, 28.06.2019

Erdoğan Sökmen Levent Özdemir Mustafa Çelik

Öz

ÖZET

Arka plan ve Amaç: Hipertansiyon (HT) hastalarında non-dipping sirkadiyen patern ile artmış aortik sertlik

derecesi, morbidite ve mortalite artışı ile ilişkilidir. Bu çalışmadaki amacımız sol ventrikül çıkım yolu (SVÇY)

üzerinde transtorasik doppler ekokardiyografi (TTE) ile ölçümlenen presistolik dalganın (PSD), TTE ile ölçülen

aortik sertlik parametreleri ile ilişkisinin olup olmadığının değerlendirilmesidir.

Metot: Kardiyoloji polikliniğine başvuran ve yeni hipertansiyon teşhisi konan ardışık 140 hasta çalışmaya

dahil edildi. Fizik muayene, laboratuar analizi, TTE ve ambülatuar kan basınç monitörizasyonu (AKBM) ile

ilişkili veriler arşiv taraması yoluyla retrospektif olarak elde edildi. Hastalar, AKBM sonuçlarına göre dipper

(75 hasta) ve non-dipper (65 hasta) şeklinde alt gruplara ayrıldı. PSD velositesi ile sirkadiyen patern ve aortik

sertlik arasındaki ilişki incelendi.

Bulgular: PSD tepe velositesi, dipper ve non-dipper HT hasta alt grupları arasında benzerdi. Spearman korelasyon

analizinde PSD ile aortik sertlik indeksi (r=0.286; p=0.007), transmitral A velositesi (r=0.260; p=0.017),

E/A oranı (r= -0.265; p=0.015) ve lateral E' velositesi (r= -0.279; p=0.013) arasında anlamlı korelasyon izlendi.

Çok değişkenli lineer regresyon analizinde aortik sertlik indeksinin (ß =0.525, p<0.001), yaşın (ß =0.239,

p=0.009), lateral E/E’ oranının (ß =0.636, p<0.001) ve E/A oranının (ß =-0.503, p<0.001), PSD velositesi için

önemli öngördürücüler olduğu tespit edilmiştir.

Sonuç: Şayet mevcut ise, yeni tanı hipertansiyon hastalarında SVÇY üzerinden ölçülen PSD velositesi, TTE ile

değerlendirilen aortik sertlik derecesi ve sol ventrikül kompliansı ile ilgili bilgi sağlayabilmekte olup sirkadiyen

kan basıncı paternini öngördürmede yarar sağlamamaktadır.

Anahtar Kelimeler: Presistolik dalga; Aortik sertlik; Sirkadiyen patern; Esansiyel hipertansiyon

ABSTRACT

Background and Aim: Non-dipping circadian pattern and increased aortic stiffness have been linked to

increased morbidity and mortality in patients with hypertension (HT). Our aim in the present study was

to assess whether presystolic wave (PSW) velocity measured by Doppler transthoracic echocardiography

(TTE) on left ventricular outflow tract (LVOT) had relationship with circadian pattern and the aortic stiffness

parameters assessed by TTE.

Methods: A total of 140 newly-diagnosed essential HT patients admitting to the cardiology outpatient

polyclinic were consecutively included. Data regarding physical examination, laboratory analysis, TTE,

and ambulatory blood pressure monitoring (ABPM) were obtained retrospectively from medical records.

Patients were divided into dipper (n=75) and non-dipper (n=65) groups on the basis of ABPM. Relationship

of PSW velocity with circadian pattern and aortic stiffness was evaluated.

Results: Peak PSW velocity was similar between dipper and non-dipper HT subgroups. Spearman’s

correlation analysis showed a positive correlation of PSW velocity with aortic stiffness index (r=0.286;

p=0.007), transmitral A velocity (r=0.260; p=0.017), E/A ratio (r=-0.265; p=0.015), and lateral E’ velocity

(r=-0.279; p=0.013). In multivariate lineer regression model, aortic stiffness index (ß=0.525, p<0.001), age

(ß=0.239, p=0.009), lateral E/E’ ratio (ß=0.636, p<0.001) and E/A ratio (ß=-0.503, p<0.001) emerged as

significant predictors of PSW velocity.

Conclusion: Peak velocity of PSW on LVOT, if present, may provide information about the status of aortic

stiffness and LV compliance assessed by TTE. However, PSW velocity is not useful in the prediction of

circadian blood pressure pattern in newly-diagnosed essential HT patients.

Keywords: Presystolic wave; Aortic stiffness; Circadian pattern; Essential hypertension

Anahtar Kelimeler

YENİ TANI ESANSİYEL HİPERTANSİYON HASTALARINDA PRESİSTOLİK DALGA AORTİK SERTLİK DERECESİNİ ÖNGÖRDÜREBİLMEKTE

Kaynakça

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