Leonida GHERASIM, Andrea O. CIOBANU, Carmen Lucia GHERGHINESCU, Raluca DULGHERU, Stefania MAGDA, Ruxandra DRAGOI GALRINHO, Maria FLORESCU, Suzana GUBERNA, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background: Blood pressure variability (BPV) was proved as a cardiovascular risk factor. One of its mechanisms is related to arterial stiffness and ventriculo-arterial coupling; however its impact on subclinical cardiovascular dysfunction has not been evaluated yet.

Objectives: To assess the relationship between BPV on 24 hours, and subclinical left ventricle (LV), renal, and vascular dysfunction in diabetic and hypertensive patients. Material and methods: We studied 56 patients (57±9 years, 29 men) with mild-to-moderate hypertension and type 2 diabetes, no cardiovascular disease, normal ejection fraction and normal renal function. 24 hours ambulatory blood pressure monitoring (ABPM) was used to assess BPV, daytime (d) and night time (n), by: 1. mean (M); 2. standard deviation of mean (SD); 3. variance (Vr); 4. coefficient of variation (CV); 5. day/night variation: reverse dippers, non-dippers, dippers and extreme dippers; conventional and 2D speckle tracking echo to assess LV function; myocardial deformation was measured as global longitudinal strain (GLS). Endothelial (flow mediated dilation, FMD) and arterial function (intima media-thickness, IMT; pulse wave velocity, PWV), microalbuminuria were tested.

Outcomes: Daytime BPV correlates inversely with subclinical myocardial function evaluated through GLS. Daytime systolic BPV correlates positively with IMT (all rho > 0.30, all p < 0.05). Also, there is a significantly inverse correlation between mean BP and GLS. We found a direct correlation between mean BP, but not BPV, and microalbuminuria (all rho > - 0.30 and all p < 0.05). We found no correlation between BPV and FMD, PWV. There were no differences for GLS, microalbuminuria and FMD between dipper groups.

Conclusions: In diabetic patients with mild-to-moderate hypertension, increased daytime blood pressure variability correlates with subclinical left ventricular dysfunction and arterial function (IMT), while microalbuminuria correlates with elevated blood pressure, but not with blood pressure variability.

Keywords: blood pressure variability, ventricular dysfunction, diabetes, hypertension

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Nora TOMA, Ruxandra DRAGOI GALRINHO, Gabriela BICESCU, Raluca ENACHE, Mircea CINTEZA and Leonida GHERASIM

ABSTRACT

Background: The cardiopulmonary test has demonstrated its role in predicting long term prognostic of patients with heart failure, but only few data are available regarding its utility on short term period.

Methods: During 2011-2013, the study enrolled 55 patients over 18 years, with different cardiovascular, metabolic and/or pulmonary pathologies, and 10 control patients matched for age, sex and surgical intervention type, without an associated pathological history who underwent elective abdominal surgery with general anesthesia.

Results: The most important predictors of the heart failure worsening after abdominal surgery were peak VO2 as percent of predicted VO2 lower than 59.42±12.52, ventilator equivalent for CO2 at anaerobic threshold over 39.53±5.27 and VD/VT ratio at anaerobic threshold over 0.33±0.06. Lean VO2 lower than 9.58±2.47 also correlated with the above mentioned complication. The ventilator equivalent for CO2 , above 39.53±5.27 at anaerobic threshold, respectively 40.67±6.73 at peak exercise, correlates with short term worsening of heart failure after general anesthesia for abdominal surgery.

Conclusion: The CPX test has a certain value in predicting short term worsening of heart failure after general anesthesia for elective abdominal surgery in patients known with cardiovascular, pulmonary and/or metabolic disorders.

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