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42 ORIGINAL ARTICLE Aortic flow propagation velocity as an early predictor of high coronary risk in hypertensive patients Mustafa Yıldırım 1 , Omer Yiginer 2 , Mehmet Uzun 2 , Bekir Yilmaz Cingozbay 2 , Cemal Sag 1 , Hasan Kutsi Kabul 1 , Omer Uz 2 , Zafer Isilak 2 , Ejder Kardesoglu 2 , Bekir Sitki Cebeci 2 1 2 Department of Cardiology, Gulhane Military Medical School, Etlik, Ankara, Department of Cardiology, Gulhane Military Medical Academy, Uskudar, Istanbul; Turkey Corresponding author: Omer Yiginer GATA Haydarpasa Egitim Hastanesi Kardiyoloji servisi- Uskudar 34667, Istanbul; Turkey Phone: + 90 50 581 85 590; fax.: 90 21 654 22 000; E-mail: oyiginer@yahoo.com Original submission: 04 April 2011; Revised submission: 15 June 2011; Accepted: 18 June 2011. ABSTRACT Med Glas Ljek komore Zenicko-doboj kantona 2012; 9(1):42-48 Aim To assess the value of aortic flow propagation velocity (Vp) in detecting hypertensive patients with coronary risk. Methods The study included 120 patients with hypertension. According to the 10-year risk of coronary heart disease the patients were categorized in the three groups: 10-year risk 20% (III). The aortic flow propagation velocity (Vp) was measured from descending aorta with color M-mode echoardiography. The slope of the first aliasing contour was accepted as Vp. It was compared with Framingham coronary risk score, carotid intima media thickness and high sensitive C-reactive protein. Twelve patients were excluded from the study due to poor acoustic window. Results The Vp was significantly lower (p
INTRODUCTİON Atherosclerosis and related complications are the leading cause of death (1). Its early diagnosis and treatment is very important for decreasing cardiovascular deaths. There has been substantial number of investigations in this area, especially in coronary atherosclerosis, in the last four decades (2-4). The major difficulty in diagnosis of coronary atherosclerosis is to detect those patients who are at high risk but without any symptoms (3). In the detection of such patients, some risk scoring systems are suggested. Framingham Coronary Risk Scoring (FCRS) is the mostly used one (5). In this scoring system, 10-year risk of future coronary event is graded according to the LDL- and HDL-cholesterol levels, gender, blood pressure, smoking, diabetes mellitus and age. However, in a study by Khot et al (6), it was found that 40% of those patients with coronary artery disease have only one traditional risk factor while a substantial amount of others does not have any. Therefore, there happened a shift from treatment according to the risk factors to treatment according to the early diagnosis of atherosclerosis. There are some parameters that are frequently used for early diagnosis of atherosclerosis. A new parameter with higher diagnostic power, which is user friendly, and cheaper than the other methods would be helpful in assessment of atherosclerosis (3, 4). For this aim, we compared the aortic flow propagation velocity (Vp) with carotid intima media thickness (IMT), high sensitive C-reactive protein (hs-CRP) as markers of atherosclerosis and coronary risk in patients with essential hypertension. PATIENTS AND METHODS The patients The study included 120 consecutive patients with hypertension who had been admitted to outpatient cardiology clinics of Gulhane Military Medical Academy during September 2005. The inclusion criteria were the presence of essential hypertension, age >18 years of age, and acceptance of participation in the study. The exclusion criteria were the presence of heart valve disease, pericardial effusion (effusion less than 5 mm adjacent to the posterior wall was accepted normal), previous aortic or heart surgery, any active infection, Yıldırım et al Aortic flow propagation velocity any malignancy, hematocrite 52%, pacemaker implantation, acute coronary syndrome in previous 6 months, impaired systolic function (left ventricular ejection fraction 140/90 mmHg on three consecutive measurements with one week intervals, smoking (cigarette smoking for at least one year), diabetes mellitus (meeting the criteria proposed by the American Diabetes Association) (7), Framingham Coronary Risk Score (FCRS) (coronary risk score as defined in the related study) (8). The patients were grouped according to the 10year risk of coronary heart disease in the three groups: 10-year risk 20% (III). Ultrasonographic examinations All patients were asked to rest and not to smoke or eat or drink anything for at least one hour before echocardiographic examination. The ECG was used to adjust appropriate timing. The examinations were made with Vivid 3 echocardiography device (GE, Norway) equipped with 3 MHz transducer for cardiac examination and 7.5-10 MHz transducer for carotid examination. The cardiac examination was performed while the patient was in lateral decubitus position. The carotid examination was performed while the patient is in supine position and head slightly directed towards the opposite side of the examined artery. The aortic examination was performed while the patient is in supine position with all extremities extended in a relaxed tone. The routine cardiac examination included all M-mode, B-mode, Doppler and Color Doppler examinations (9). The measurements Aortic flow propagation velocity (Vp). During aortic examination, the transverse and descending aorta was viewed from suprasternal window. The ultrasonic beam was alligned parallel to the lumen of descending aorta with the cursor located at the center of the lumen.(Figure 1) The color M-mode recording of the proximal descending aorta was obtained. The aliasing velocity 43
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