Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more ➡
Download
Standard view
Full view
of .
Add note
Save to My Library
Sync to mobile
Look up keyword
Like this
2Activity
×
0 of .
Results for:
No results containing your search query
P. 1
Mechanical factors of cardiovascular risk in systemic arterial hypertension. A new sign of arterial rigidity

Mechanical factors of cardiovascular risk in systemic arterial hypertension. A new sign of arterial rigidity

Ratings: (0)|Views: 524|Likes:

More info:

Published by: GUIMEDIC ASOCIACIÓN MÉDICA on Jun 29, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See More
See less

08/23/2012

pdf

text

original

 
Otras secciones deeste sitio:
Others sections in this web site:
 Arculo:
Mechanical factors of cardiovascularrisk in systemic arterial hypertension.A new sign of arterial rigidity
Derechos reservados, Copyright © 2003Instituto Nacional de Cardiología Ignacio Chávez
Número
 Number 
4
Octubre-Diciembre
October-December 
2003
Volumen
Volume
73
 
261
MGVol. 73 Número 4/Octubre-Diciembre 2003:261-270
edigraphic.com
* Instituto Nacional de Cardiología “Ignacio Chávez”.Correspondencia: Dr. Gustavo Sánchez Torres. Instituto Nacional de Cardiología “Ignacio Chávez” (INCICH, Juan Badiano 1, Col.Sección XVI, Tlalpan 14080, México D.F.). Tel. 5573 5255 ext. 1386 Fax. 5573 0926 E-mail: gsancheztorres@yahoo.com.mxRecibido: 11 de febrero de 2003Aceptado: 23 de julio de 2003
INVESTIGACIÓN CLÍNICA
 Mechanical factors of cardiovascular risk in systemicarterial hypertension. A new sign of arterial rigidity
Gustavo Sánchez-Torres*, Oscar Infante-Vázquez,* Gustavo Sánchez-Miranda,* Ángel deLeón-Peña,* Raúl Martínez Memije*
Summary
Antecedent:
By means of sphygmokinetocardio-graphy (SKCG) we developed and arterial rigid-ity index (ARI) which measure the pulse waveaortic carotid reflexion time over the left ventric-ular ejection time (LVET). This index, together withthe pulse wave velocity (PWV) and the pulsepressure (PP) are indicators of arterial stiffness.In this paper we measured these index in 27 sys-temic artery hypertension. Cases (group A, GA),with and without left ventricular hypertrophy (sub-groups: A
1
SGA
1
, n = 13, and A
2
, SGA
2
, n = 14),respectively, and 28 normotensive cases (groupB, GB).
Protocol:
In two occasions: after 3 min-utes of sitting position (SP) and after 3 minute of jogging in an upright position (UP), blood pres-sure, ARI, PP, PWV (aortic–hand finger distance/ aorto–hand finger pulse time) and R–IV interval(electrocardiographic R wave–left early ventric-ular kinetocardiography deflexion) were mea-sured.
Results:
Demography was similar in GAand GB. Systolic, diastolic and pulse pressurewere significantly higher in GA
vs 
GB. LVET (ms)was lower in GA
vs 
GB in SP (268 ± 42
vs 
274 ±40, p < 0.001, respectively) and higher postexer-cise UP (280 ± 42
vs 
244 ± 46, p < 0.001). PWVm/s were higher in SP in GA vs GB (9.8 ± 2.8
vs 
7.4 ± 1.2, p < 0.001, respectively) and in UP (10.1± 1.9
vs 
7.9 ± 9, p < 0.001, respectively). ARIwas lower in UP in GA
vs 
GB (0.48 ± 0.3
vs 
0.80± 0.3, p < 0.003). Correlation index of PP
vs 
SBP,
vs 
DBP and
vs 
PWV were significant in SP andin UP. Height had a significant correlation
vs 
ARIin SP and UP (r = 0.60, p < 0.01, and r = 0.42, p
Resumen
F
ACTORES
 
MECÁNICOS
 
DE
 
RIESGO
 
CARDIOVASCULAREN
 
LA
 
HIPERTENSIÓN
 
ARTERIAL
 
SISTÉMICA
. U
NNUEVO
 
SIGNO
 
DE
 
RIGIDEZ
 
ARTERIAL
Antecedentes:
Mediante esfigmoquinetocardiogra-f
í
a (EQCG) se desarroll
ó
un
í
ndice de rigidez arte-rial (IRA) que mide el tiempo aorto
 –
onda de reflexi
ó
narterial sobre el per
í
odo expulsivo. Este
í
ndice juntocon la velocidad de la onda del pulso (VOP) y lapresi
ó
n del pulso (PP) son signos de rigidez arte-rial. Aqu
í
medimos estos indicadores en 27 casoscon hipertensi
ó
n arterial (grupo A, GA) con y sinhipertrofia del ventr
í
culo izquierdo: subgrupo A
1
,SGA
1
de 13 casos y 14 individuos (subgrupo A
2
,SGA
2
) respectivamente y 28 casos normotensos(grupo B, GB).
Protocolo:
En 2 ocasiones: despu
é
sde 3 minutos de posici
ó
n sedente (PS) y despu
é
sde 3 minutos de trote en posici
ó
n ortost
á
tica (PO),se midi
ó
: la presi
ó
n arterial (PA), el IRA, la VOP (dis-tancia aorta
 –
dedo
 –
mano/tiempo de la onda delpulso aorta
 –
dedo
 –
mano) la PP y el intervalo R
 –
IV(onda R del electrocardiograma
 –
final de la deflexi
ó
nventricular temprana en el EQCG.
Resultados:
Lademograf
í
a fue similar en ambos grupos. La PP, laspresiones sist
ó
lica y diast
ó
lica fueron m
á
s altas enel GA
vs 
el GB. El PE (ms) fue menor en el GA
vs 
elGB en PS (268 ± 42
vs 
274 ± 40, p < 0.001, res-pect.) y m
á
s alto en PO (280 ± 42
vs 
244 ± 46, p <0.001) en el GA
vs 
GB. La VOP, m/s, fue m
á
s alta enPS en GA
vs 
GB (9.8 ± 2.8
vs 
7.4 ± 1.2, p < 0.001,respect.) y en PO (10.1 ± 1.9
vs 
7.9 ± 9, p < 0.001,respect.). El IRA fue menor en PO en el GA
vs 
GB(0.48 ± 0.3
vs 
0.8 ± 0.3, p < 0.003). El
í
ndice de
 
MGG S
á
nchez-Torres y cols.
262
www.archcardiolmex.org.mx
edigraphic.com
Introduction
here is a dynamic and structural state of blood vessel hyperigidity in arterialsystemic hypertension which increasesthe velocity of forward and retrograde arterialpulses,
1
and changes the circulatory reflectionsites. This favors the early arrival of reflexivewaves to the aortic root. The latter phenomenonalters the ventricular-aortic relationship, elevat-ing the central systolic pressure and the arterialpulse pressure. It also boosts the telesystolic pa-rietal stress of the left ventricle causing coronarycirculation dysfunction.
2-4
The deleterious effect of the above mentionedmechanical impairment is of epidemiological andclinical importance: population studies have re-vealed that increased pulse wave velocity (PWV)and increased arterial pulse pressure are risk fac-tors for left ventricular hypertrophy (LVH),
5
to-tal cardiovascular damage
6
and myocardial in-farction.
7
Furthermore, transversal studies havedemonstrated that these indicators are associa-ted with brain hemorrhage,
8
cutaneous hyperten-sive microvascular changes,
9
renal failure-indu-ced cardiovascular damage
10
and advanced age,to mention a few.
11
Because pulse pressure can be easily measured,considerable interest has risen to apply this mea-surement in everyday clinical practice.
12
Nume-rous publications have shown that increased pulsepressure is a more potent cardiovascular risk in-dicator than systolic or diastolic blood pressu-res,
13
even though the latter have proven predic-tive value.
14
Moreover, the relationship betweenpulse pressure and arterial rigidity has been clear-ly established in experimental observations.
15,16
A clinical physiographic method called digitalsphygmokinetocardiography was recently deve-loped at our hospital.
1
This method is useful to
< 0.05, respectively).
Conclusion:
PWV is in-creased in GA
vs 
GB patients. The ARI index islower in GA
vs 
GB cases in post exercise. PWVand PP showed a statistical significant correla-tion; height
vs 
ARI had also a significant corre-lation: SKCG is a new method, that uses a notcommercially instrument, which should have clin-ical application.correlaci
ó
n de la PP
vs 
PAS, PA y VOP tuvo signifi-cancia estad
í
stica en PS y en PO. La talla correla-cion
ó
con el IRA (r = 0.6, p < 0.01 en PS y r = 0.42,p < 0.05 en PO).
Conclusiones:
La VOP est
á
au-mentada y el IRA m
á
s bajo en el GA vs GB en PO(lo que indica mayor rigidez arterial). La VOP y laPP tuvieron correlaci
ó
n significativa con la talla aligual que esta
ú
ltima con el IRA. La EQCG es unm
é
todo con aplicaci
ó
n cl
í
nica.(Arch Cardiol Mex 2003; 73:261-270).
Palabras clave:
Mec
á
nica arterial, Hipertensi
ó
n arterial, Velocidad del pulso, Reflexi
ó
n arterial.
Key words:
Aarterial mechanicsm, Arterial Hypertension, Pulse velocity, Arterial reflexion.
study important hemodynamic aspects of cardio-arterial function, as the following signals can beobtained from a patient in sitting position and instanding position after exercise: electrocardiogra-phy signals, finger photoplethysmography (f-PP),carotid oscillation pulse signals, as well as vi-briograms generated by the contraction of the an-terior and posterior left ventricle walls registeredon the precordium and the subcostal abdominalaspect respectively.
1,17
Based on this method, wedeveloped an arterial rigidity index (ARI) whichmeasures the interference caused by the arterialreflection wave to left ventricle ejection time in-terval.
18
In the present study we analyze ARI, pulsewave velocity and pulse pressure, all indicatorsof arterial stiffness, to study hypertensive patientswith and without left ventricular hypertrophy(LVH), as well as normotensive individual.
Objective
1)To analyze the correlation between the arte-rial rigidity index and pulse wave velocity asmeasured by sphygmokinetocardiography, aswell as with systolic, diastolic and pulse pres-sures, in order to assess the relevance of theseparameters in detecting arterial rigidity in ev-eryday clinical practice.2)To study the aortic-finger pulse wave veloci-ty, the arterial reflection index and the elec-trocardiographic R–IV interval in hypertensi-ve patients with and without LVH.
Methods
This clinical study was transversal, prospective,and analyzed age and gender matched cases andcontrols.
Subjects.
We analyzed a total of 55 individualsbelonging to two different groups: group A in-cluded 27 outpatients aged > 30 years and diag-

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->