Diastolic dysfunction, left ventricular and vascular remodeling in hypertensive patients with obesity

Abstract

Objective. To investigate the peculiarities of left ventricular (LV) remodeling, diastolic dysfunction (DD) and common carotid artery (CCA) remodeling in hypertensive patients with obesity. Design and method. 75 hypertensive patients (32 male, 43 female) with preserved LV systolic function had been observed, including 51 obese patients (21 male, 30 female). An ultrasound examination of heart (including estimation of transmitral blood flow and mitral valve annulus motion parameters) and CCA was performed. LV geometric pattern, E/A and E/Em ratios, ring segment weight (VM) of CCA were calculated. The statistical analysis was conducted using Mann-Whitney and Pearson χ2 methods. Results. Normal LV geometrical pattern was observed in 6 (11,8%) obese patients and 4 (16,7%) – without obesity, p>0,05; concentric remodeling – 7 (13,7%) and 1 (4,2%), p>0,05; concentric hypertrophy (CH) – 29 (56,9%) and 8 (33,3%), р=0,028; eccentric hypertrophy – (EH) 9 (17,6%) and 10 (41,7%), р=0,015. LV CH prevalence in obese patients was significantly higher compared to EH, p<0,0001. Patients with obesity had higher LVMM (309,3±15,9 vs 258,8±16,8 g, p<0,05), but not MMI (148,5±7,1 vs 139,7±7,9 g/m2, p>0,05). LV DD was revealed in 48 (94,1%) obese patients (including 23 (100%) with II-III st. obesity) and 19 (79,1%) – without obesity, p=0,05. Type I of DD was observed in 31 (60,8%) obese patients, type II – in 17 (33,3%), p=0,028; in non-obese patients – 12 (50,0%) and 7 (29,2%) accordingly, p=0,07. CCA wall hypertrophy was observed in 44 (86,3%) obese patients (including 22 (95,7%) with II-III st. obesity) and 18 (75,0%) – without obesity, p<0,01. The values of mitral valve annulus motion parameters, intimal medial thickness and ring segment weight of CCA are given below as median [LQ; UQ]. Conclusion. Hypertensive patients with obesity were characterized by higher prevalence of LV hypertrophy, concentric patterns of remodeling and DD. Indices of CCA remodeling were also increasing along with BMI. Tissue Doppler parameters of mitral valve annulus motion are important early markers of LV DD.