Carotid Body Enlargement in Patients with Hypertension and Comorbid Diseases: a CT Angiographic Study

Yıl 2023, , 299 - 305, 30.06.2023

Gözde Özer , Lale Damgacı

https://doi.org/10.18663/tjcl.1264052

Öz

Aim: To determine the carotid body (CB) size and its relationship with hypertension, other sympathetically mediated disorders and smoking.
Materials and Methods: Neck CT angiographies of 180 patients performed in our clinic in the previous year were included in the study. The patients' histories were assessed for hypertension (HT), congestive heart failure (CHF), diabetes mellitus (DM), chronic obstructive pulmonary disease and smoking. The study groups were smokers without any chronic condition (S group, n=21), patients with HT alone (HT group, n=26), patients that had at least two chronic disorders (CD+S group, n=78) and the controls (n=33). The widest axial diameter of the CB was measured on axial sections.
Results: CB diameter could be measured in 158 patients. The CB diameter was significantly greater in HT (2.77±3.28 mm, p=0.02) and CD+S (2.76±3.38 mm, p<0.01) groups compared to the controls (2.22±3.41 mm). There was no significant difference between the S group (2.47±3.44 mm) and the control group (p=0.123). Repeated measurements showed a high intra-observer correlation for both sides.
Conclusion: HT causes a significant increase in CB size. CB size also increases significantly in individuals with the combination of sympathetically mediated disorders, including HT, CHF, and DM. CTA may provide a better understanding of the relationship between CB and sympathetically mediated diseases and guide further studies as well as therapies targeting CB.

Anahtar Kelimeler

computed tomography, carotid body, hypertension

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Karotid Cisim Boyutlarının Hipertansiyon ve Komorbid Hastalıklarla İlişkisi: BT Anjiyografik Çalışma

Öz

Amaç: Karotid cisim (KC) boyutlarının hipertansiyon, sempatik sistem hiperaktivasyonunun görüldüğü diğer hastalıklar ve sigara ile ilişkisinin araştırılması.
Gereç ve Yöntemler: Son bir yıl içerisinde kliniğimizde boyun bilgisayarlı tomografi (BT) anjiyografi tetkiki yapılmış olan hastalar çalışmaya dahil edildi. Hastaların klinik öykülerinden hipertansiyon, konjestif kalp yetmezliği (KKY), diyabetes mellitus (DM), kronik obstrüktif akciğer hastalığı ve sigara içiciliği durumları kaydedildi. Hastalar yalnız sigara içen ve hiç komorbid hastalığı olmayan (Grup S, n=21), yalnızca hipertansiyonu olan (Grup HT, n=26), en az 2 komorbid hastalığa sahip olan (Grup KH, n=78) hastalar ve kontrol grubu (n=33) olmak üzere 4 gruba ayrıldı. BT anjiografi kesitlerinde KC’nin aksiyal planda en uzun aksı ölçüldü.
Bulgular: KC boyutu 158 hastada ölçülebildi. KC boyutu, grup HT’de (2,77±3.28 mm, p=0,02) ve grup KH’de (2,77±3,28 mm, p=0,02) kontrol grubu (2,22±3,41 mm) ile karşılaştırıldığında anlamlı olarak daha fazlaydı. Grup S (2,47±3,44 mm) ile kontrol grubu arasında anlamlı farklılık saptanmadı (p=0,123). Tekrarlanan ölçümlerde her iki taraf için yüksek gözlemci içi uyum saptandı (ICC=0,91/0,94).
Sonuçlar: Hipertansiyonu olan hastalarda KC boyutu artmaktadır. Ayrıca KC boyutu hipertansiyon, KKY ve DM gibi sempatik hiperaktivasyonun görüldüğü diğer hastalıklarda da anlamlı olarak artış göstermektedir. BT anjiyografi, KC ile sempatik hiperaktivasyonun görüldüğü hastalıklar arasındaki ilişkinin daha iyi anlaşılmasının yanında bu alandaki çalışmalarda ve tedavi seçeneklerinde yol gösterici olabilir.

Anahtar Kelimeler

bilgisayarlı tomografi, karotid cisim, hipertansiyon

Proje Numarası

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Kaynakça

• 1. Iturriaga R, Alcayaga J, Chapleau MW, Somers VK. Carotid body chemoreceptors: physiology, pathology, and implications for health and disease. Physiol Rev. 2021;101:1177-1235.
• 2. Abdala AP, McBryde FD, Marina N, et al. Hypertension is critically dependent on the carotid body input in the spontaneously hypertensive rat. J Physiol. 2012;590:4269-4277.
• 3. Siński M, Lewandowski J, Przybylski J, et al. Tonic activity of carotid body chemoreceptors contributes to the increased sympathetic drive in essential hypertension. Hypertens Res. 2012;35:487-491.
• 4. Ponikowski P, Chua TP, Anker SD, et al. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation. 2001;104:544-549.
• 5. Nimbkar NV, Lateef F. Carotid body dysfunction: the possible etiology of non-insulin dependent diabetes mellitus and essential hypertension. Med Hypotheses. 2005;65:1067-1075.
• 6. Koyama Y, Coker RH, Stone EE, et al. Evidence that carotid bodies play an important role in glucoregulation in vivo. Diabetes. 2000;49:1434-1442.
• 7. Sivridis E, Pavlidis P, Fiska A, Pitsiava D, Giatromanolaki A. Myocardial hypertrophy induces carotid body hyperplasia. J Forensic Sci. 2011;56.
• 8.Sinski M, Lewandowski J, Przybylski J, et al. Deactivation of carotid body chemoreceptors by hyperoxia decreases blood pressure in hypertensive patients. Hypertens Res. 2014;37:858-62.
• 9. Pijacka W, Moraes DJ, Ratcliffe LE, et al. Purinergic receptors in the carotid body as a new drug target for controlling hypertension. Nat Med. 2016;22:1151-1159.
• 10. Nguyen RP, Shah LM, Quigley EP, Harnsberger HR, Wiggins RH. Carotid body detection on CT angiography. AJNR Am J Neuroradiol. 2011;32:1096-1099.
• 11. Cramer JA, Wiggins RH, Fudim M, Engelman ZJ, Sobotka PA, Shah LM. Carotid body size on CTA: correlation with comorbidities. Clin Radiol. 2014;69:e33-e36.
• 12 Nair S, Gupta A, Fudim M, et al. CT angiography in the detection of carotid body enlargement in patients with hypertension and heart failure. Neuroradiology. 2013;55:1319-1322.
• 13. Swieton D, Kaszubowski M, Szyndler A, et al. Visualizing Carotid Bodies With Doppler Ultrasound Versus CT Angiography: Preliminary Study. AJR Am J Roentgenol. 2017;209:1348-1352.
• 14. Arnold SM, Strecker R, Scheffler K, et al. Dynamic contrast enhancement of paragangliomas of the head and neck: evaluation with time-resolved 2D MR projection angiography. Eur Radiol. 2003;13:1608-1611.
• 15. Paton JF, Sobotka PA, Fudim M, et al. The carotid body as a therapeutic target for the treatment of sympathetically mediated diseases. Hypertension. 2013;61:5-13.
• 16. Jaźwiec P, Gać P, Poręba M, Sobieszczańska M, Mazur G, Poręba R. The volume of the carotid bodies and blood pressure variability and pulse pressure in patients with essential hypertension. Clin Radiol. 2016;71:616.e7-616.e13.
• 17. Pacheco-Ojeda L, Durango E, Rodriquez C, Vivar N. Carotid body tumors at high altitudes: Quito, Ecuador, 1987. World J Surg. 1988;12:856-860.
• 18. Heath D, Edwards C, Harris P. Post-mortem size and structure of the human carotid body. Thorax. 1970;25:129-140.
• 19. McBryde FD, Abdala AP, Hendy EB, et al. The carotid body as a putative therapeutic target for the treatment of neurogenic hypertension. Nat Commun. 2013;4:2395.
• 20. Del Rio R, Marcus NJ, Schultz HD. Carotid chemoreceptor ablation improves survival in heart failure: rescuing autonomic control of cardiorespiratory function. J Am Coll Cardiol. 2013;62:2422-2430.
• 21. Marcus NJ, Del Rio R, Schultz EP, Xia XH, Schultz HD. Carotid body denervation improves autonomic and cardiac function and attenuates disordered breathing in congestive heart failure. J Physiol. 2014;592:391-408.
• 22. Niewinski P, Janczak D, Rucinski A, et al. Dissociation between blood pressure and heart rate response to hypoxia after bilateral carotid body removal in men with systolic heart failure. Exp Physiol. 2014;99:552-561.
• 23. Niewinski P, Janczak D, Rucinski A, et al. Carotid body resection for sympathetic modulation in systolic heart failure: results from first-in-man study. Eur J Heart Fail. 2017;19:391-400.
• 24. Narkiewicz K, Ratcliffe LE, Hart EC, et al. Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial. JACC Basic Transl Sci. 2016;1:313-324.