Kul Selim, Dursun İhsan, Sayın Muhammet Raşit, Şahin Sinan, Turan Turhan, Akyüz Ali Rıza, Korkmaz Levent, Karadeniz Ayşegül, Yılmaz Ahmet Seyda, Durmuş İsmet
Department of Cardiology, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Saglik Bilimleri Universitesi (University of Health Sciences), Trabzon, Turkey.
Department of Radiology, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Saglik Bilimleri Universitesi (University of Health Sciences), Trabzon, Turkey.
Echocardiography. 2019 Feb;36(2):237-242. doi: 10.1111/echo.14217. Epub 2018 Dec 5.
Carotid intima media thickness (CIMT), a direct marker of atherosclerosis, has emerged as a promising means for cardiovascular risk evaluation. Presystolic wave (PSW) is commonly detected by the Doppler interrogation of the left ventricular outflow tract (LVOT). It is thought to be a result of a stiff left ventricle and impaired LV compliance. Herein, we aimed to investigate a possible association between carotid intima media thickness, an atherosclerotic marker, and PSW.
We prospectively enrolled 282 patients divided into two groups based on the presence of PSW: 221 (89F; mean age: 49.3 ± 11.5 years) had PSW on Doppler examination while 61 patients (32F; mean age: 46.4 ± 10.3 years) did not. Both groups were compared with respect to demographic, clinical properties, and CIMT.
Both groups had comparable age, body mass index, and diabetes mellitus, hypertension, dyslipidemia, smoking, and family history for coronary heart disease. PSW-positive group had significantly higher CIMT (PSW-positive: 0.59 ± 0.22 mm vs PSW-negative: 0.42 ± 0.11 mm; P < 0.001) than PSW-negative group. Multivariate analysis showed that the independent predictors of increased CIMT were age (95% CI; 1.044-1.101, P < 0.001), dyslipidemia (95% CI; 0.147-0.664, P = 0.002), and the presence of PSW (95% CI; 2.168-7.836, P < 0.001).Correlation analysis showed that PSW velocity is correlated with increased CIMT in PSW-positive group (r: 0.418, P < 0.001).
Assessment of PSW on TTE is easy and feasible method. Presence of PSW and increased PSW velocity on TTE might provide information that we should be careful in terms of subclinical atherosclerosis.
颈动脉内膜中层厚度（CIMT）是动脉粥样硬化的直接标志物，已成为心血管风险评估的一种有前景的手段。收缩前期波（PSW）通常通过对左心室流出道（LVOT）进行多普勒检查来检测。它被认为是左心室僵硬和左心室顺应性受损的结果。在此，我们旨在研究动脉粥样硬化标志物颈动脉内膜中层厚度与PSW之间可能存在的关联。
我们前瞻性地纳入了282例患者，根据是否存在PSW将其分为两组：221例（89例女性；平均年龄：49.3±11.5岁）在多普勒检查时有PSW，而61例患者（32例女性；平均年龄：46.4±10.3岁）没有。比较了两组的人口统计学、临床特征和CIMT。
两组在年龄、体重指数、糖尿病、高血压、血脂异常、吸烟和冠心病家族史方面具有可比性。PSW阳性组的CIMT显著高于PSW阴性组（PSW阳性：0.59±0.22mm vs PSW阴性：0.42±0.11mm；P<0.001）。多变量分析显示，CIMT增加的独立预测因素是年龄（95%CI；1.044-1.101，P<0.001）、血脂异常（95%CI；0.147-0.664，P=0.002）和PSW的存在（95%CI；2.168-7.836，P<0.001）。相关性分析显示，PSW阳性组中PSW速度与CIMT增加相关（r：0.418，P<0.001）。
经胸超声心动图（TTE）上对PSW的评估是一种简单可行的方法。TTE上PSW的存在和PSW速度的增加可能提供信息，提示我们在亚临床动脉粥样硬化方面应予以关注。
