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Analysis of echocardiographic findings in patients with primary and secondary hypertension using new sophisticated modalities
Kvasnička, Jan ; Holaj, Robert (advisor) ; Wohlfahrt, Peter (referee) ; Danzig, Vilém (referee)
6 Abstract Introduction: Heart damage in essential hypertension (EH) is one of the most serious consequences of high blood pressure. However, in the case of secondary hypertension, multiple pathophysiological effects may apply. For example, pheochromocytomas (PHEOs), which are tumors arising from the chromaffin cells of the adrenal medulla, have the ability to produce, metabolize, and secrete catecholamines. Overproduction of catecholamines leads to cardiac and other impairments by many mechanisms. The aim of our work was to verify this fact and at the same time to investigate whether global longitudinal strain (GLS), measured using speckle tracking echocardiography, can detect this damage earlier and also determine the adjustment of function after adrenalectomy. Methods: We analyzed 17 patients with PHEO and 18 patients with EH with the same hemodynamic parameters. Subsequently, we managed to increase the number of patients with PHEO to 24, and they were also examined 1 year after adrenalectomy. Results: Patients with PFEO did not differ in echocardiographic parameters including left ventricular ejection fraction compared to EH (0.69 ± 0.04 vs. 0.71 ± 0.05; NS), however, they had significantly lower GLS (−14.8 ± 1.5 vs. −17.8 ± 1.7; p < 0.001). One year after adrenalectomy, the GLS parameter improved...
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Metabolic and Genetic Factors of Vascular Ageing
Gelžinský, Július ; Mayer, Otto (advisor) ; Petrák, Ondřej (referee) ; Wohlfahrt, Peter (referee)
Arterial system is a system of vessels distributing blood. Ageing of arterial system leads to two distinct pathologies: atherosclerosis and arteriosclerosis - stiffening of arterial wall. These pathologies can coexist and interfere; however, they differ in their pathogenesis, location, scope and consequences. Progressive loss of elastic properties of large arteries is natural part of vascular ageing. It is directly responsible for several age dependent consequences, such as increase of central systolic pressure or prevalence of isolated systolic hypertension in the elderly. Clinically, central arteries stiffness manifests as aortic pulse wave velocity, which can be quantified, among other methods, using applanation tonometry. There is abundant evidence that aortic pulse wave velocity represents an independent predictor of cardiovascular mortality and morbidity. The most important mechanism in arterial stiffening is repeated mechanical damage which leads to fractures, fragmentation and thinning of elastin. Stiffening of large arteries can be accelerated by several other mechanisms, e.g. deposition of several substances (calcium, advanced glycation end-products, etc.), metabolic turnover of key elements of vascular extracellular matrix (collagen and elastin) or individual genetic susceptibility. In...
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The relationship between lower extremity arterial properties and aortic stiffness and their effect on cardiovascular risk
Wohlfahrt, Peter ; Cífková, Renata (advisor) ; Karetová, Debora (referee) ; Bulvas, Miroslav (referee)
The ratio of systolic blood pressure at the ankle to arm systolic pressure (ankle- brachial index - ABI) is used in the diagnosis of peripheral vascular disease. While its reduced value suggests obstruction of the arterial lumen, an abnormally elevated value is due to incompressibility of lower extremity arteries. While increased stiffness of the aorta, measured as carotid-femoral pulse wave velocity, is able to predict cardiovascular risk, increased pulse wave velocity of the leg arteries has no independent predictive value. Despite that, incompressibility of lower extremity arteries, diagnosed using ABI measurement, is independently associated with increased cardiovascular risk. The aim of our study was to determine the relationship between the characteristics of lower limb arteries and aortic stiffness, and their impact on cardiovascular risk. Our study showed that the results of oscillometric and Doppler ABI measurement methods are not interchangeable, because the oscillometric method systematically overestimates low values and underestimates high ABI values. Therefore, the diagnosis of lower limb arteries incompressibility should be based on the Doppler method of ABI measurement. Furthermore, we showed that age and cardiovascular risk factors have only a small effect on lower extremity arteries, but a...
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The relationship between lower extremity arterial properties and aortic stiffness and their effect on cardiovascular risk
Wohlfahrt, Peter ; Cífková, Renata (advisor) ; Karetová, Debora (referee) ; Bulvas, Miroslav (referee)
The ratio of systolic blood pressure at the ankle to arm systolic pressure (ankle- brachial index - ABI) is used in the diagnosis of peripheral vascular disease. While its reduced value suggests obstruction of the arterial lumen, an abnormally elevated value is due to incompressibility of lower extremity arteries. While increased stiffness of the aorta, measured as carotid-femoral pulse wave velocity, is able to predict cardiovascular risk, increased pulse wave velocity of the leg arteries has no independent predictive value. Despite that, incompressibility of lower extremity arteries, diagnosed using ABI measurement, is independently associated with increased cardiovascular risk. The aim of our study was to determine the relationship between the characteristics of lower limb arteries and aortic stiffness, and their impact on cardiovascular risk. Our study showed that the results of oscillometric and Doppler ABI measurement methods are not interchangeable, because the oscillometric method systematically overestimates low values and underestimates high ABI values. Therefore, the diagnosis of lower limb arteries incompressibility should be based on the Doppler method of ABI measurement. Furthermore, we showed that age and cardiovascular risk factors have only a small effect on lower extremity arteries, but a...
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