Early carotid atherosclerosis and cardiac diastolic abnormalities in hypertensive subjects

Abstract

Despite the fact that it is known that hypertension may be associated to early atherosclerosis manifestations, few data are to date available on the relationship between early carotid abnormalities and left ventricular diastolic dysfunction. To address this issue, 142 hypertensive patients (64 females and 78 males) younger than 55 years, at the first diagnosis of mild-tomoderate essential hypertension (WHO/ISH criteria), were selected from a database consisting of 3541 subjects referred to ultrasound cardiovascular laboratory in the last 5 years. Carotid intima-media thickness (IMT) was detected by high-resolution vascular ultrasound and left ventricular structure and function by the use of Doppler echocardiography. According to carotid IMT values, all patients were subgrouped into two groups consisting of 89 (62.6%) pts with IMT X1 mm (A) and 53 (37.4%) pts with IMT o1 mm (B). Our results show that isovolumic relaxation time (IVRT), deceleration time of E velocity (EDT) and left ventricular relative wall thickness (LV-RWT) were significantly (Po0.05) higher in group A (IVRT 112 7 8.9 ms; EDT 288 7 21.8 ms; LV-RWT 0.40 7 0.08) than in group B (IVRT 92.3 7 4.6 ms; EDT 203.3 7 27.01 ms; LV-RWT 0.37 7 0.06). Moreover, the prevalence of left ventricular hypertrophy (LVH) was significantly (Po0.01) higher in group A (30/89; 33.7%) than in group B (8/53; 15%). A positive correlation (Po0.001) between IMT, EDT and IVRT was found only in hypertensives without LVH. These results are consistent with the indication that IMT evaluation has to be recommended both in hypertensive patients with LVH and in those without LVH, but with left ventricular diastolic dysfunction. This approach might improve the prognostic stratification of hypertensive subjects and it might be suitable to recognize the subset of patients at a higher risk of cardiovascular disease or events early.

Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography

“…CIMT testing is a noninvasive imaging modality that has been shown to correlate to systemic atherosclerosis, structural heart disease, and atrial fibrillation and predicts the risk of recurrent stroke. [1][2][3][4][5][6][7] The correlation between and CIMT and CSE on TEE among patients with ischemic stroke has not been reported. Furthermore, the ability of a noninvasive testing strategy incorporating TTE bubble study for detection of intra-atrial communications and CIMT for detection of other CSEs has not been investigated.…”

“…[1][2][3][4][5][6][7] Among patients with ischemic stroke, a low CIMT has been reported to have a high negative predictive value for the detection of complex aortic plaques, which are among the most prevalent CSE identified on TEE. 8 -13 Other evidence suggests that modern transthoracic echocardiography with bubble study is highly sensitive for the detection of intra-atrial communications, another commonly identified potential CSE after stroke.…”

Arterial stiffness and left-ventricular diastolic dysfunction: Guangzhou Biobank Cohort Study-CVD

“…We found no association between E/A ratios and IMT in our population. Previous Western studies in hypertensive patients and with small sample size have shown that carotid IMT was associated with markers of diastolic function [29][30][31][32][33] such as isovolumic relaxation time and DT. However, data on the relationship between E/A ratio and carotid IMT were scarce, with only one Japanese study reported an unadjusted insignificant association.…”

Clinical significance of subclinical carotid atherosclerosis and its relationship with echocardiographic parameters in non-diabetic chronic kidney disease patients

“…In certain populations, however, the prevalence becomes much higher: 15-25% in subjects with hypertension or PAD [8,9], and up to 70% in patients with CAD [10]. Our data showed a fairly high prevalence of subclinical carotid atherosclerosis in non-diabetic CKD patients; about half of the patients (54.4%) had carotid atherosclerosis, and most of them had carotid plaque.…”