Utilitat de la tonometria arterial perifèrica per a l’avaluació del risc cardiovascular

Identificador:  TDX:1555

Handle: https://hdl.handle.net/20.500.11797/TDX1555

Autors:  Ferré Vallés, Raimon

Resum:
• Contributions and new knowledge: This work demonstrates that the peripheral artery tonometry is a useful technique for the cardiovascular risk evaluation and is associated to endothelial dysfunction markers, arterial stiffness and morphologic lesions of the arterial wall. Therapeutic life-style changes may cause improvement on digital reactive hyperaemia index. These findings may contribute to a more accurate cardiovascular risk stratification of patients. • Methods and main relevant conclusions: The studies described are based in 816 patients without cardiovascular disease and at moderate cardiovascular risk recruited from the Vascular Medicine and metabolism clinic of the Hospital Universitari Sant Joan in Reus. Clinical visits, blood analyses, therapeutic life-style changes, carotid ultrasonography methods and endothelial function and arterial stiffness evaluation are described in each study. Main results showed that small artery reactivity is directly associated with HDL cholesterol levels and indirectly with tobacco habit, abdominal circumference and triglyceride levels. Central arterial stiffness calculated by the augmentation index was the main determinant of the carotid intimae-media thickness together with the LDL cholesterol levels and the systolic arterial pressure. A one-year prospective study on the therapeutic life-style changes impact on arterial reactivity in 150 volunteers showed that those patients with better adherence presented endothelial function improvement and lower carotid intimae-media thickness progression. Furthermore, the augmentation index measured in 125 patients with familial hypercholesterolemia was positively associated with carotid intimae-media thickness and Apo B100 levels. Endothelial function biomarkers were analysed in order to investigate the relation of this techniques with biochemical markers of cardiovascular risk. The E-selectin, sVCAM levels and the oxLDL/LDL ratio were associated to a lower reactive hyperaemia in a subgroup of 407 patients. The FABP4 was analysed in 257 patients with type 2 diabetes mellitus and was associated with a worse endothelial function.