Anjiyografik olarak koroner arter yapısı normal bulunan olgularda metabolik sendromun aort distensibilitesi üzerine etkisi
Date
2010
Authors
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Metabolik sendrom, kardiyovasküler riski artıran bir durumdur. Metabolik sendromlu hastalarda aort sertliği artmaktadır. Bu çalışmada, metabolik sendrom tanısı alan ve anjiyografik olarak koroner arterleri normal saptanan hastalarda, metabolik sendromun invaziv olarak ölçülen aortik sertlik parametrelerine olan etkilerini ortaya koymayı amaçladık.Çalışmaya Erişkin tedavi paneli-III (ATP-III) ölçütlerine göre metabolik sendrom tanısı konan 30 hasta (4 erkek, 26 kadın; ort. yaş 52±7,8) ve kontrol grubu olarak metabolik sendrom tanısı bulunmayan 20 hasta (8 erkek, 12 kadın; ort. yaş 54±9,3) alındı. Hastaların kan basınçları, nabız basıncı, bel çevresi ve kan örneklerinde total kolesterol, HDL-kolesterol, LDL-kolesterol, trigliserid, açlık kan şekeri ve insülin düzeyi ölçüldü. Hemodinamik ölçümler hasta yatar pozisyonda kardiyak kateterizasyon yapımı esnasında değerlendirildi, aort sistolik ve diyastolik çapları ölçüldü ve aort sertliğinin göstergeleri olan aort gerilimi (strain) ve esneyebilirliği (distendibilite) hesaplandı.Metabolik sendrom grubunda, kontrol grubu ile karşılaştırıldığında beklendiği üzere sistolik ve diyastolik kan basıncı, nabız basıncı, bel çevresi, trigliserid düzeyi, açlık kan şekeri değerleri daha yüksek, HDL-kolesterol düzeyleri düşük bulundu (p<0,05). Metabolik sendrom grubunda aort gerilimi (% 6±1,4 ve % 5,8±1,7; p=0,181) istatistiksel olarak anlamlı olmasa da daha yüksek saptandı, esneyebilirlik (1,6±0,5 cm2.dyn-1.10-3 ve 2,5±0,5 cm2.dyn-1 .10-3; p<0,001) ise istatistiksel olarak anlamlı olarak daha düşük idi. Aort esneyebilirliğinin bel çevresi (r= -0,589, p<0,001), açlık kan şekeri (r= -0,721, p<0,001), sistolik kan basıncı (r= -0,729, p<0,001), diyastolik kan basıncı ( r= -0,425, p=0,002) ve nabız basıncı (r=-0,676, p<0,001) ile anlamlı olarak ilişkili olduğu görüldü. Aort esneyebilirliğinin bağımsız değişken seçildiği çok değişkenli regresyon analizinde, sistolik kan basıncı (ß=-0,17, p=0,004) ve açlık kan şekeri (ß=-0,16, p=0,11) ile aortun esneyebilirliği arasında bağımsız ilişki saptandı.Sonuç olarak; biz bu çalışma ile metabolik sendrom tanısı alan hastalarda invaziv olarak bakılan aort sertlik parametrelerinden aortik gerilimin kontrol grununa kıyasla artmış ve esneyebilirliğin ise azalmış olduğunu gösterdik. Metabolik sendromlu hastalarda arteryel sertlik değerlendirilerek ve risk faktörlerine yönelik tedavi ile kardiyovasküler hastalıklar ve mortalitede azalma sağlanabilir.
Metabolic syndrome is a condition which increases cardiovascular risk. Aortic stiffness is increased in patients with metabolic syndrome. In this study we aimed to investigate the parameters of aortic stiffness that were measured angiographically and the factors that effect these parameters in patients diagnosed as metabolic syndrome and whose coronary arteries were normal anjiografically.Thirty patients with metabolic syndrome (4 men, 24 women and mean age 52±7,8) and twenty patients without metabolic syndrome (8 men, 12 women and mean age 54±9,3) were included. The metabolic syndrome was diagnosed according to Adult treatment panel III (ATP III) criteria. The blood pressures, pulse pressures, waist circumference were measured and total cholesterol, HDL cholesterol, LDL cholesterol, trigliserit, fasting plasma glucose and insulin levels were studied from the blood samples. Hemodynamic measurements were made during cardiac catheterization while the patients were in supine position. The systolic and diastolic diameters of aorta were measured and parameters associated with aortic stiffness, aortic strain and distensibility, were estimated.When compared with the control group the systolic and diastolic blood pressure, pulse pressure, waist circumference, trigliserid and fasting plasma glucose levels were higher and HDL cholesterol level was lower in the metabolic syndrome group (p<0,05). Aortic strain was higher in metabolic syndrome group but the statistical relation was not significant (%6±1,4 ve %5.8±1,7; p=0,181). Moreover the distensibility was lower in metabolic syndrome group and the statistical relation was significant (1,6±0,5 cm2.dyn-1 .10-3 ve 2,5±0,5 cm2.dyn-1.10-3; p<0,001). The aortic distensibility was found to be associated with waist circumference (r= -0,589, p<0,001), fasting plasma glucose (r= -0,721, p<0,001), systolic (r= -0,729, p<0,001) and diastolic blood pressure (r=-0,425, p=0,002) and pulse pressure (r=-0,676, p<0,001). In multiple regression analysis in which aortic distensibility was chosen as independent variable, systolic blood pressure (ß=-0,17, p=0,004) and fasting plasma glucose levels (ß=-0,16, p=0,11) were found to be related to aortic distensibilty independently.In coclusion, in this study we showed that aortic strain which is a parameter of aortic stiffness evaluated invasively is increased and aortic distensibility is decreased in the study group compared to the control group. Patients with metabolic syndrome should be evaluated about aortic stiffness. Thus morbidity and mortality of these patients can be prevented by treatment of risk factors.
Metabolic syndrome is a condition which increases cardiovascular risk. Aortic stiffness is increased in patients with metabolic syndrome. In this study we aimed to investigate the parameters of aortic stiffness that were measured angiographically and the factors that effect these parameters in patients diagnosed as metabolic syndrome and whose coronary arteries were normal anjiografically.Thirty patients with metabolic syndrome (4 men, 24 women and mean age 52±7,8) and twenty patients without metabolic syndrome (8 men, 12 women and mean age 54±9,3) were included. The metabolic syndrome was diagnosed according to Adult treatment panel III (ATP III) criteria. The blood pressures, pulse pressures, waist circumference were measured and total cholesterol, HDL cholesterol, LDL cholesterol, trigliserit, fasting plasma glucose and insulin levels were studied from the blood samples. Hemodynamic measurements were made during cardiac catheterization while the patients were in supine position. The systolic and diastolic diameters of aorta were measured and parameters associated with aortic stiffness, aortic strain and distensibility, were estimated.When compared with the control group the systolic and diastolic blood pressure, pulse pressure, waist circumference, trigliserid and fasting plasma glucose levels were higher and HDL cholesterol level was lower in the metabolic syndrome group (p<0,05). Aortic strain was higher in metabolic syndrome group but the statistical relation was not significant (%6±1,4 ve %5.8±1,7; p=0,181). Moreover the distensibility was lower in metabolic syndrome group and the statistical relation was significant (1,6±0,5 cm2.dyn-1 .10-3 ve 2,5±0,5 cm2.dyn-1.10-3; p<0,001). The aortic distensibility was found to be associated with waist circumference (r= -0,589, p<0,001), fasting plasma glucose (r= -0,721, p<0,001), systolic (r= -0,729, p<0,001) and diastolic blood pressure (r=-0,425, p=0,002) and pulse pressure (r=-0,676, p<0,001). In multiple regression analysis in which aortic distensibility was chosen as independent variable, systolic blood pressure (ß=-0,17, p=0,004) and fasting plasma glucose levels (ß=-0,16, p=0,11) were found to be related to aortic distensibilty independently.In coclusion, in this study we showed that aortic strain which is a parameter of aortic stiffness evaluated invasively is increased and aortic distensibility is decreased in the study group compared to the control group. Patients with metabolic syndrome should be evaluated about aortic stiffness. Thus morbidity and mortality of these patients can be prevented by treatment of risk factors.
Description
Keywords
Kardiyovasküler hastalık, Esneyebilirlik, Metabolik sendrom, Cardiovascular disease, Distensibility, Metabolic syndrome
Citation
Emül, A. (2010). Anjiyografik olarak koroner arter yapısı normal bulunan olgularda metabolik sendromun aort distensibilitesi üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.