Impaired Endothelial Glucocalyx is Related With Abnormal Aortic and Coronary Function in Newly Diagnosed Untreated Hypertensives
Ignatios Ikonomidis; Astrinos Voumvourakis; Helen Triantafyllidi; George Pavlidis; Mary Varoudi; Ioannis Papadakis; Maria Anastasiou-Nana; John Lekakis
2nd Cardiology Dept, Univ of Athens, Attikon Hosp, Univ of Athens, Athens, Greece
The integrity of endothelial glucocalyx plays a vital role in vascular permeability, inflammation and elasticity. The association between damage of endothelial glucocalyx, impaired arterial elastic properties impaired coronary microcirculation, and hypertension has not been explored.
Methods: In 50 untreated patients (age: 54±11 years) with essential hypertension and 20 controls of similar age and sex we measured a) carotid-femoral pulse wave velocity (PWVc m/sec-Complior SP ALAM) and central systolic blood pressure (cSBP -mmHg), pulse pressure (cPP-mmHg) and augmentation index (AI %-Arteriograph,TensioMed) b) LV longitudinal (GLS -%), strain, using speckle tracking echocardiography and coronary flow reserve (CFR) of the LAD after adenosine infusion using Doppler echocardiography c) perfusion boundary region (PBR- micrometers) of the sublingual arterial microvessels (ranged from 5-25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) Increased PBR is considered an accurate non invasive index of reduced endothelial glucocalyx thickness.
Results: Compared to controls, hypertensives had higher PBR (2.0±0.17 vs. 1.77±0.14), PWVc (10±2 vs. 8.5±2,), cSBP ( 140±21 vs. 95±20), cPP ( 46±17 vs. 30±5,),, AI (28±16 vs. 15±10) and lower CFR (2.5±0.7 vs. 3.5±1) and GLS (-17±4 vs. -22±2.5, p<0.05 for all comparisons).
Reduced endothelial glucocalyx thickness as assessed by increased PBR was related with increased clinic SBP (r=0.41), DBP (r=0.50) , cSBP (r=0.50), cPP (r=0.36), AI (r=0.20) and reduced CFR (r=-0.30) (p<0.05 for all associations). These associations were more prominent for PBR measured in the microvessels ranged from 20-25 micrometers. Increased PWV and cSBP were related with reduced GLS (r=0.35, r=0.40) and CFR (r=-0.40 r=-0.35) respectively (p<0.05 for all associations) while reduced CFR was also associated with impaired GLS (r=0.36) (p<0.05 for all associations)
Conclusion: Endothelial glucocalyx is impaired in newly diagnosed untreated hypertensives and is related with abnormal aortic elastic properties and coronary microcirculatory function leading to impaired LV longitudinal deformation.
Author Disclosures: I. Ikonomidis: None. A. Voumvourakis: None. H. Triantafyllidi: None. G. Pavlidis: None. M. Varoudi: None. I. Papadakis: None. M. Anastasiou-Nana: None. J. Lekakis: None.