Relationship Between Atherosclerosis Renal Artery Stenosis And Left Ventricular Hypertrophy

BackgroundHigh blood pressure(HBP)is one of the most common seen chronic diseases currently.With the development of aging population and the change of the social circumstance and life style,the prevalence of HBP is consequently higher and higher yearly,and incidence of hypertension gets in younger trend.Long-term uncontrolled hypertension might be associated with severe complications,such as stroke,heart failure,chronic renal insufficiency,and sudden death.According to the etiology,hypertension is classified into essential hypertension(EH)and secondary hypertension.Nowadays,with the progress of the technology of test and examination,the detection rate of secondary hypertension is improved significantly.Contemporary surveys show,about 1%-3% of the hypertensive patients are caused by renal artery stenosis(RAS),80% of which is atherosclerotic renal artery stenosis(ARAS).Renal arteriography is the gold standard of the diagnosis of renal artery stenosis.The clinical diagnosis of ARAS depends on typical feature of arteriography,which performs as an initial,eccentric and irregular lesion,with the risk factors of atherosclerosis.However,renal arteriography is expensive and invasive.Therefore,preoperative screening should be emphasized.Theclinical manifestations of ARAS are mostly concealed and not specific,so to find out the clinical characteristics may be significant.Left ventricular hypertrophy(LVH)is a common cardiac injury in patients with hypertension.LVH is typically characterized by cardiac myocyte hypertrophy,increase of myocardial tissue mass and remodeling of myocardium.Currently,echocardiogram is used to clarify the diagnosis of LVH.Several studies found LVH is closely associated with the occurrence and progress of cardiovascular diseases(CVD),and may be a ideal surrogate marker for major adverse cardiovascular events(MACE).The treatment of reversion of myocardial remodeling may be an important link to reduce the occurrence of cardiovascular events.At the same time,several animal experiments showed that the renal artery stenosis was closely related to the occurrence of left ventricular hypertrophy.However,whether there is any differences between the occurrence of left ventricular hypertrophy in patients with atherosclerotic renal artery stenosis and essential hypertension,current clinical studies is still few.ObjectiveTo analyse the relationship between atherosclerotic renal artery stenosis and left ventricular hypertrophy.MethodsWe retrospectively analyzed hypertensive inpatients underwent the renal arteriography in the first affiliated hospital of Zhengzhou university,from March2014 to March 2017,and 245 people were included.Patients with other secondary high blood pressure have been excluded.According to the results of renal artery angiography,these patients were divided to two groups: ARAS group(n=86),non-ARAS(n=159).Comparisons of the general data,laboratory examinations,the results of coronary angiography and echocardiogram in two groups of patients were conducted.The degree of coronary artery disease was quantified by GENSINI scoring system,and LVMI is used to assess the LVH.Logistic regression analysis was conducted,with taking ARAS or not as dependent variable and statistically different features as independent variables.Results1.Comparison of general information: There were no significant differences in gender,age,smoking history,drinking history,diabetes,duration of hypertension,systolic blood pressure and pulse pressure between ARAS group and non-ARAS group(P > 0.05).Diastolic blood pressure in ARAS group was significantly higher than that in non-ARAS group(P=0.011).2.Comparison of clinical examination and test data: no significant differences in NT-proBNP,blood potassium,HbA1 c,TCHO,TG,HDL,LDL,BUN,UA,peripheral vascular disease,LAD between two groups(P> 0.05).The eGFR of ARAS group was lower than that of non-ARAS group,and the score of SCR,LVMI and GENSINI was higher than that of non-ARAS group.3.Single factor Logistic regression analysis showed that left ventricular hypertrophy,GENSINI score ? 22.5,renal function injury,and diastolic pressure were risk factors for ARAS formation.4.Multivariate logistic regression showed that left ventricular hypertrophy,GENSINI score ? 22.5,diastolic blood pressure and renal function damage had independent predictive value for diagnosing ARAS.The area under the ROC curve was 0.742(95%CI:0.681~0.803,P < 0.001).Conclusions1.Atherosclerosis renal artery stenosis is closely related to the occurrence of left ventricular hypertrophy.The incidence of left ventricular hypertrophy in ARAS patients is higher than that in patients with essential hypertension.2.Left ventricular hypertrophy,coronary heart disease,diastolic pressure and renal function injury are of predictive value for the diagnosis of ARAS.