cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2020-35-2-98-105cardiotomsk-982Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESРиск развития хронической сердечной недостаточности у больных гипертонической болезнью в зависимости от истинной жесткости артерийThe risk of developing chronic heart failure in patients with hypertension depending on the actual arterial stiffnesshttps://orcid.org/0000-0002-0051-6694ЧернявинаА. И.ChernyavinaA. I.

канд. мед. наук, доцент кафедры пропедевтики внутренних болезней № 2,

614990, Пермь, ул. Петропавловская, 26

Cand. Sci. (Med.), Associate Professor, Department of Propaedeutics of Internal Diseases No. 2,

26, Petropavlovskaya str., Perm, 614990

anna_chernyavina@list.ruhttps://orcid.org/0000-0001-7003-5186КозиоловаН. А.KoziolovaN. A.

д-р мед. наук, профессор, заведующий кафедрой пропедевтики внутренних болезней № 2,

614990, Пермь, ул. Петропавловская, 26

Dr. Sci. (Med.), Professor, Head of Department of Propaedeutics of Internal Diseases No. 2,

 26, Petropavlovskaya str., Perm, 614990

nakoziolova@mail.ruПермский государственный медицинский университет имени академика Е.А. Вагнера Министерства здравоохранения Российской ФедерацииРоссияPerm State Medical University named after Academician E.A. WagnerRussian Federation20201007202035298105Copyright © Чернявина А.И., Козиолова Н.А., 20202020Чернявина А.И., Козиолова Н.А.Chernyavina A.I., Koziolova N.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/982Цель

Цель: определить риск развития хронической сердечной недостаточности (ХСН) у больных гипертонической болезнью (ГБ) в зависимости от истинной жесткости артерий.

Материал и методы

Материал и методы. В исследование были включены 175 пациентов с ГБ без верифицированного диагноза ХСН. Средний возраст составил 48,5 ± 6,8 лет. Пациентам проводились общеклинические обследования, объемная сфигмоплетизмография с оценкой сердечно-лодыжечно-сосудистого индекса (CAVI, Cardio-ankle vascular index), эхокардиография с оценкой фракции выброса левого желудочка (ФВ ЛЖ), диастолической функции ЛЖ, индекса массы миокарда ЛЖ, индексированного объема левого предсердия, определение концентрации N-терминального фрагмента предшественника мозгового натрийуретического пептида (NT-proBNP) в крови. Пациенты были разделены на две группы в зависимости от индекса CAVI. Первую группу составил 141 (80,6%) пациент с индексом CAVI < 9, 2-ю группу – 34 (19,4%) пациента с индексом СAVI > 9.

Результаты

Результаты. У пациентов 1-й группы уровень NT-proBNP составил 0,008 [0,006; 5,770], что было статистически значимо ниже, чем во 2-й группе, где уровень NT-proBNP составил 13,08 [0,01; 350,65] нг/мл (р = 0,041). Показатели отношения шансов (ОШ) и относительного риска (ОР) также были статистически значимыми. Шанс развития ХСН при индексе CAVI > 9 увеличивался почти в 7 раз (ОШ = 6,9; 95% ДИ = 2,8–16,8), а ОР ее развития составлял 4,1 (95% ДИ = 2,2–7,6). Чувствительность и специфичность составили 55,9 и 84,4% соответственно. При проведении корреляционного анализа выявлена прямая, средней степени взаимосвязь между уровнем NТ-proBNP и индексом CAVI (r = 0,35; p < 0,05).

Заключение

Заключение. Результаты работы свидетельствуют о том, что у больных ГБ риск развития ХСН, определяемый по повышению концентрации NТ-proBNP в сыворотке крови, зависит от истинной жесткости артерий. Пациенты с индексом CAVI > 9, отражающим увеличение истинной артериальной жесткости, имеют больший риск развития ХСН, оцениваемый по концентрации NТ-proBNP в крови. Оценка влияния артериальной жесткости, регистрируемой в пределах промежуточных значений индекса CAVI, на риск возникновения ХСН требует дальнейшего изучения. 

Objective

Objective. To determine the risk of developing chronic heart failure (CHF) in patients with hypertension (HTN) depending on the actual arterial stiffness.

Material and Methods

Material and Methods. The study included 175 patients with HTN without a verified diagnosis of heart failure. The average age was 48.5 ± 6.8 years. Patients underwent general clinical examination, volume sphygmoplethysmography assessments of cardio-ankle vascular index (CAVI), echocardiography study (left ventricular (LV) ejection fraction, LV diastolic function, LV myocardial mass index, indexed LV volume by echocardiography), and tests for serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). Patients were divided into two groups depending on CAVI. Group 1 included 141 (80.6%) patients with CAVI < 9; group 2 included 34 (19.4%) patients with CAVI > 9.

Results

Results. In patients of group 1, the level of NT-proBNP was 0.008 [0.006; 5.770], which was significantly lower than the corresponding value in group 2, where the level of NT-proBNP was 13.08 [0.01; 350.65] ng/mL (p = 0.041). Indicators of odds ratio (OR) and relative risk (RR) were also significant. The chance of developing CHF with CAVI > 9 increased by almost 7 times (OR = 6.9; 95% CI = 2.8–16.8), and OR of CHF onset was 4.1 (95% CI = 2.2–7.6). Sensitivity and specificity rates were 55.9% and 84.4%, respectively. Correlation analysis revealed a medium degree of dependence and direct relationships between NT-proBNP level and CAVI values (r = 0.35; p <0.05).

Conclusion

Conclusion. Serum level of NT-proBNP depended on the actual arterial stiffness. Patients with CAVI > 9 indicative of an increase in true arterial stiffness had a greater risk of developing heart failure assessed based on the level of NT-proBNP in the blood. Further studies are required to assess the effects of arterial stiffness, registered within the intermediate values of CAVI index, on the risk of heart failure onset. 

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The authors declare that there are no conflicts of interest present.