Nghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátNghiên cứu chỉ số tương hợp tâm thất – động mạch ở bệnh nhân tăng huyết áp nguyên phátPhụ lục VI INTRODUCTION 1 The urgency of the subject In recent studies, left ventricular function and left ventricular aortic coupling has been demonstrated to play a critical role in the pathophysiol.
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE MILITARY MEDICAL UNIVERSITY BUI THUY DUONG VENTRICULAR - ARTERIAL COUPLING IN PRIMARY HYPERTENSIVE PATIENTS Major: Internal medicine Code: 9720107 SUMMARY OF MEDICAL DOCTORAL THESIS HA NOI - 2023 STUDY COMPLETED AT MILITARY MEDICAL UNIVERSITY SUPERVISOR: Assoc.,Prof PhD NGUYEN OANH OANH Reviewer 1: Assoc Prof PhD Pham Quoc Khanh Reviewer 2: Assoc Prof PhD Luong Cong Thuc Reviewer 3: Assoc Prof PhD Pham Nguyen Son This thesis will be defended at School-level Thesis Evaluation Councial at Military Medical University at: … o’clock, on ……………… 2023 Thesis can be found at: National Library Library of Military Medical University INTRODUCTION The urgency of the subject In recent studies, left ventricular function and left ventricularaortic coupling has been demonstrated to play a critical role in the pathophysiology of cardiovascular disease such as hypertension, heart failure Chen C.H et al developed and tested a novel fully noninvasive estimation method, that is, single-beat analysis and validated it against invasive measurement His study showed similar findings between two methods the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) reached a consensus to use Ea (arterial elastance), Ees (left ventricularend-systolic elastance) and the ventricular-arterial coupling (VAC or Ea/Ees) for echocardiographic assessment, prognosis, and management of hypertension In Vietnam, there have been few reports on ventricular arterial coupling in primary hypertensive patients since our initial researches in 2010 Objectives of the thesis: ➀ To investigate value of ventricular arterial coupling (VAC) and its components as well as its association with anthropometric features and cardiovascular disease risk factors among primary hypertensive patients ➁ To identify the relationship of VAC and its components with morphology, left ventricular and arterial function among primary hypertensive individuals Scientific and practical significance of the research - Having determined the value of left ventricular arterial coupling (VAC) and its components (Ea, EaI, Ees, EesI) in primary hypertensive patients, in which there were changes in ventricular and arterial elasticity compared with people with normal cardiovascular functions - Having determined the value of Ea, EaI, Ees, EesI, and VAC and its association with gender, age, BMI and cardiovascular disease risk factors in in primary hypertensive patients - Having evaluated the relationship between Ea, EaI, Ees, EesI and VAC with echocardiographic characteristics and stages of heart failure in primary hypertensive individuals This contributes to explain some pathophysiology variations in hypertension, predict and early detect the complications of this disease such as diastolic and systolic dysfunctions Thesis structure - The thesis has 134 pages, including pages of Introduction, 35 pages of Overview, 24 pages of Subjects and Methods, 33 pages of Results, 35 pages of Discussion, pages of Conclusion, and page of Recommendation - There are 37 tables, 15 figures with 135 references, including 10 in Vietnamese and 125 in English The published works related to the thesis, studying protocol and list of participating subjects are also included Chapter OVERVIEW 1.1 Hypertension 1.1.1 Definition Hypertension is defined as office SBP values ≥140 mmHg and/or diastolic BP (DBP) values ≥90 mmHg, and the diagnosis of hypertension should be based on at least two BP measurements (ESC/ESH 2018) 1.2 Left ventricular arterial coupling 1.2.1 What is the left ventricular arterial coupling ? 1.2.1.1 End systolic elastance–Ees The crossing points where the end-systolic pressure and volume intersect each other on the the pressure–volume loop is called the end-systolic pressure-volume relationship - ESPVR This relationship is reasonably linear, and independent of the arterial pressures The LV end-systolic elastance (Ees or Elv) is quantified as the slope of ESPVR demonstrating the LV contractility 1.2.1.2 Arterial elastance - Ea On the pressure–volume (PV) loop, Sunagawa and coworkers characterized a slope joining the end-diastolic volume (EDV) and the end-systolic pressure (ESP) points demonstrating the augmentation of arteries to respond to the increase of left ventricle’s stroke volume This slope is called the effective arterial elastance (Ea) 1.2.1.3 Ventricular-Arterial Coupling - VAC VAC demonstrates the interaction between Ea and Ees by the ratio: 1.2.2 Calculating VAC and its components by non-invasive methods 1.2.2.1 End systolic elastance Ees was calculated by the modified single-beat method by Chel which was proved to be equavalent to other invasive methods The fomular is: in which : End(est) = 0.0275 − 0.165 × EF + 0.3656 × (Pd/Ps × 0.9) + 0.515 × End(avg) End(avg) = 0.35695 − 7.2266 × tNd + 74.249 × tNd2−307.39 × tNd3 + 684.54 × tNd4 – 856.92 × tNd5+ 571.95 × tNd6 − 159.1 × tNd7 Pd: diastolic pressure; Ps: systolic pressure obtained at the upper arm; tNd: ratio of preejection period to total systolic period; SV: stroke volume measured by Simpson’s method The unit of Ees(sb) is mmHg/ml,a nd its normal range is 2.3 ± 1.0 mmHg/ml 1.2.2.2 Arterial elastance Due to Pes ≈ 0.9 x Ps, therefore Pes: end systolic pressure; Ps: systolic pressure obtained at the upper arm; tNd: ratio of preejection period to total systolic period; SV: stroke volume measured by Simpson’s method The unit of Ea is mmHg/ml, and its normal range is 2.2 ± 0.8 mmHg/ml 1.2.2.3 VAC: The VAC value obtained by this method was proved to be equivalent to invasive mesusements 1.3 Reaserches on VAC in healthy people and in some diseases 1.3.1 Overseas 1.3.1.1 In healthy people According to Chen (1998), the values of Ees was 2.3 ± 1.0 mmHg/ml, Ea was 2.2±0.8 mmHg/ml, VAC was 1.0 ± 0.36 Ea, Ees increased gradually with age and had a relation with gender 1.3.1.2 In hypertensive patients In a research by Cohen-Solal A (1994), the Ea and Ees in hypertensive patients were 15% – 60% and 60% - 95%, respectively higher than those in normotensive one; and the Ea/Ees ratio was equivalent According to Saba (1995), both Ea and ELV grew up in men with hypertension EaI/ELVI in women with systolic hypertension was 23% lower than those without hypertension due to the equivalent increase of E LVI compared with EaI (45% vs 16%, respectively) According to Scali (2012), Ees had a strong corelation with EF (r = 0.73), but no corelation was seen between Ea/Ees and SVR (r = - 0.04) Therapeutic options to improve VAC: According to Martin Osranek (2008), after treatment, Ea and VAC deceased, Ees increased, which were early signs of left ventricular remodeling In a research by Lam CS (2013), lowering BP could help to improve Ea, Ees, and Ea/Ees and thereby improving the left ventricular function and slowering the hyperstrophy Some medications like angiotensin converting enzyme inhibitor, angiotensin receptor blockers and dihydropyridine (calcium channel blockers) might have some effects to this parameter Chapter SUBJECTS AND METHODS 2.1 Subjects The subjects were 228 adults (over 18 years old ), divided into the control and the hypertension group in 103 Military Hospital from October 2014 to December 20120 2.1.1 Control group The control group consisted of 69 people having no cardiovascular disease and no other condition affecting heart and vascular functions 2.1.2 Hypertension group - Inclusion criteria 159 primary hypertensive patients who were eligible for the criteria by WHO – ISH (2013) and Vietnam Heart Association 2008 received inpatient treatment at Department of Internal Medicine and Cardiology, 103 Military Hospital - Exclusion criteria + Secondary hypertension + Severe acute diseases or cancer + Left ventricular outflow tract obstruction, coarctation of the aorta, heart valvular stenosis, or having left ventricular assist device 2.2 Methods 2.2.1 Study design: A descriptive, cross-sectional study 2.2.2 Methods of measurements in the research - Ea, Ees(sb) and VAC + Calculating Ees and EesI based on the modified single-beat method by Chel; + EesI was derived from Ees ajusted by BSA: EesI = Ees/BSA - Ea and EaI: EaI = Ea/BSA - VAC: VAC = Ea/Ees 2.2.3 Diagnotic criteria in the research a WHO – ISH (2013) and Vietnam Heart Association (2008) b NYHA classification of chronic heart failure c 2013 ACCF/AHA classification of heart failure - Heart failure with reduced EF (EF ≤ 40%) - Heart failure with preserved EF (EF ≥ 50%) - Heart failure with preserved EF, borderline (EF 41 – 49%) - Heart failure with preserved EF, improved (EF > 40%) * In this study, all types of heart failure with EF > 40% were called heart failure with preserved EF Therefore, the hypertension group was divided into subgroups: + Without heart failure: 98/159 patients + Having heart failure with preserved EF (HFpEF):31/159 patients + Having heart failure with reduced EF (HFrEF): 30/159 patients 2.2.4 Data analysis Data is processed with SPSS 20.0 software: data is presented as averages and percentages Compare the results by X-squared test, T Test, ANOVA test The difference is statistically significant when p