Dottorato in ARTERIAL HYPERTENSION AND VASCULAR BIOLOGY

Titolo della tesi: ASSESSMENT OF VENTRICULAR-ARTERIAL COUPLING IN EARLY STAGE MIDDLE-AGED HYPERTENSIVES BY CLINICAL PARAMETERS, VASCULAR ULTRASOUND AND SPECKLE TRACKING ECHOCARDIOGRAPHY

Background: By aging and cardiovascular comorbidities ventricular-arterial coupling (VAC) alters, indicating a myocardial dysfunction and/or a stiffening of the arterial system. Aim of the study: The aim of this study was to demonstrate that lifestyle changes (LC) and anti-hypertensive drug treatment (AHDT) reduced VAC in recent diagnosed early stage middle-aged hypertensives (HTN) without organ damage. Arterial elastance (Ea), carotid-femoral Pulse Wave Velocity (cfPWV), Global Longitudinal Strain (GLS) and Myocardial Work (MW) [in all its components: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)] were also investigated. Materials and methods: This retrospective observational study selected 126 individuals (mean age 40 years; 55% female), divided into two groups (HTN and NT). Clinical, echocardiographic and echo vascular parameters were assessed. LC were asked to HTN. If BP values still remained high AHDT has been administred. Results: Significant higher values of Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), Heart Rate (HR), GWI, GCW and GWW were observed in HTN. By following LC, BP (DBP and MAP), HR, VAC, Ea, cfPWV, GWE and GLS were found changed in HTN; after following 6 months AHDT, BP (SBP, DBP and MAP), HR, VAC, Ea, cfPWV, GWI, GCW, GWW, GWE and GLS were found changed. VAC was linear related to PWV and GLS at two follow ups. Discussion: No statistically significant difference in VAC between the HTN and NT was found, probably due to a small sample and lack of longitudinal analysis in NT. Along with decrease in BP, stop-smoking and HR control highlighted a significant role in cardiovascular prevention by the improvement of VAC, Ea, cfPWV, GLS and MW. Conclusions: VAC altered in middle-aged young onset hypertension with the prevalence of active smoking and increased HR. Keywords: Ventricular-arterial coupling; arterial elastance; arterial hypertension; pulse wave velocity; global longitudinal strain; myocardial work.