Nature and structure of atherosclerotic lesion of common carotid arteries depending on cardiac remodelling in patients with arterial hypertension.

Abstract

As arterial hypertension (AH) progresses, deformations, sclerosis and remodelling of both myocardium and vessels develop, which usually leads to various complications (myocardial infarctions, strokes, etc.). Modern ultrasound methods of research (echocardiography, Doppler vascular dopplerography), have provided an opportunity to differentiate structural and functional changes both in the heart and in the arteries, as well as in the ultrasound structure of formed intravascular atherosclerotic plaques (AP). At present, as a result of analysis and comparison of the accumulated clinical and instrumental data, it has become clear that APs of different echo structure have different prognostic value in terms of the possibility of complications, their rupture, emboli, etc. In connection with the above-mentioned the aim of the presented study was a comparative evaluation of the heart condition and wall structure of common carotid arteries (CCA) in patients with AH with absence and different variants of myocardial remodelling.
124 patients (86 men and 38 women) aged 27 to 81 years (mean age 55.66+1.01 years) were examined. 17 (11 men and 6 women) of them had stage I AH, 88 (66 men and 22 women) had stage II AH, and 19 (9 men and 10 women) had stage III AH. The diagnosis of ischemic heart disease (IHD) and AH was verified according to the existing modern clinical recommendations. Clinical-anamnestic and instrumental examination of patients with verification of diagnoses was performed with assessment of the variant of myocardial remodelling they had. Using echocardiographic examination (EchoCG) in one-dimensional (M) and two-dimensional (B) scanning modes, a number of parameters reflecting the state of intracardiac haemodynamics and myocardial remodelling were investigated. Ultrasound scanning was used to investigate both sides of CCA with determination of intima-media complex thickness (IMCT), detection of intravascular atherosclerotic plaques (AP), assessment of their echo structure (hypo-, hyper- and heterogeneous), haemodynamic significance (% stenosis of the vessel lumen), surface (smooth or fissured edges). The data were analyzed using Statistica 12.6 application software package.
The results of the study confirm the presence of cardiac and vascular remodelling in patients with AH, and the degree of vascular remodelling and formation of prognostically ‘unfavourable’ friable plaques in carotid arteries is in direct correlation with the presence and variant of myocardial remodelling.