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Evaluation of coronary sinus strain in patients with dipper and nondipper hypertension
Salaheddin Akcay1, Yasin Turker, Mehmet Ali Kobat
1aDepartment of Cardiology, Celal Bayar University Faculty of Medicine, Manisa bDepartment of Cardiology, Duzce University Faculty of Medicine, Duzce cDepartment of Cardiology, Elazig Education and Research Hospital, Elazıg, Turkey.
Insights
Systemic hypertension impacts the cardiac venous system, reducing coronary sinus strain (CSS). This effect is more pronounced in nondipper hypertension patterns, suggesting venous system involvement in hypertensive disease.
Area of Science:
- Cardiology
- Vascular Physiology
- Hypertension Research
Background:
- Systemic hypertension is known to affect left and right ventricular function.
- The impact of hypertension on the cardiac venous system, specifically the coronary sinus, remains under-investigated.
Purpose of the Study:
- To investigate the effect of systemic hypertension on the cardiac venous system.
- To evaluate coronary sinus strain (CSS) as a marker for hypertension's impact on venous function.
Main Methods:
- Echocardiography was used to assess coronary sinus strain (CSS) in 112 hypertensive patients and 44 healthy controls.
- Hypertensive patients were categorized into dipper (n=52) and nondipper (n=60) patterns using 24-hour ambulatory blood pressure monitoring.
Main Results:
- Nondipper hypertensive patients exhibited significantly lower CSS values compared to controls (140.8±54.2 vs. 193.9±48.1, P<0.001).
- Dipper hypertensive patients also showed significantly lower CSS values than controls (164±68.4 vs. 193.9±48.1, P=0.036).
- A progressive decrease in CSS was observed from healthy individuals to dipper and nondipper hypertensive groups, with a positive correlation between aortic strain and CSS.
Conclusions:
- Systemic hypertension appears to affect the cardiac venous system, similar to its known effects on the arterial system.
- The impact of hypertension on the cardiac venous system may be more severe in patients with the nondipper blood pressure pattern.
Objective:
Hypertension has been reported to affect both the left and the right ventricular functions, but its effect on the coronary sinus has not been investigated. The aim of this study was to investigate the effect of systemic hypertension on the cardiac venous system by evaluating the coronary sinus strain (CSS).
Methods:
One-hundred and twelve hypertensive patients without diabetes and 44 healthy individuals (the control group) were evaluated consecutively at the outpatient clinic and enrolled in the study. CSS was evaluated by echocardiography in all the participants before blood pressure evaluations. Twenty-four-hour ambulatory blood pressure monitoring enabled the study population to be divided into two groups: 52 patients with dipper pattern hypertension and 60 with nondipper pattern hypertension.
Results:
Nondipper pattern patients had significantly lower values of CSS compared with the participants in the control group (140.8±54.2 and 193.9±48.1, P<0.001). Similarly, dipper pattern patients had significantly lower values of CSS values compared with the controls (164±68.4 and 193.9±48.1, P=0.036). On comparing the three groups, the CSS values showed a progressive decrease from normal individuals to dipper and nondipper hypertension patients. Correlation analysis indicated a positive correlation between the aortic strain and the CSS (r=0.247, P=0.002). There was a weak correlation between left ventricular mass and CSS (r=-164, P=0.041).
Conclusion:
Our study suggests that systemic hypertension may affect the cardiac venous system as well as the arterial system, which has been reported in many papers. The effect on the venous system may be more pronounced in nondipper pattern hypertension.
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