Relationship Between Myocardial Acousticdensitometry And Matrix Metalloproteinase In Essential Hypertensive Patients

OBJECTIVETo evaluate the clinical value of quantitative myocardial acoustic densitometry in myocardial fibrosis in relative to the alteration in serum metalloproteinase MMP-9 and tissue metalloproteinase inhibitor(TIMP-1)concentrations in 72 essential hypertensive patients.And to investigate the relationship of left ventricular diastolic function with myocardial acoustic densitometry parameters and serum metalloproteinase MMP-9 and tissue metalloproteinase inhibitor(TIMP-1) concentrations in these patients.METHODS72 essential hypertensive patients including 36 males and 36 females according to left ventricular mass index were enrolled and divided into two groups:left ventricular hypertrophy(LVH)group including 40 patients and no left ventricular hypertrophy(NLVH)including 32 patients,with 30 normal persons served as healthy control group.The diagnostic criteria was Chinese 2005 Guideline Revised Edition for Prevention and Cure for Hypertension.No significant differences in age and sex through LVH,NLVH and healthy control groups.All patients' history were recorded in details,as well as biood pressure,height and weight in order to calculate BSA.And Monitor ambulatory blood pressure for 24 hours were measured.Left ventricular telediastolic internal diameter,interventricular septum and posterior left ventricular wall thickness were measured by Ultrasound cardiography and left ventricular mass index were calculated.Calibrated acoustic intensity in septal(CAl₁)and posterior wall(CAI₂)and cyclic variation of integrated backscatter in septal(CVIB₁)and posterior wall(CVIB₂)were measured by AD technique.E/A ratios were obtained by Pulse Doppler ultrasound.Heparin sodium anticoagulated blood 3ml was obtained simultaneously,whose blood serum was put in freezer(-20℃)to keep after centrifugalization.The concentrations of MMP-9 and TIMP-1 were obtained by enzyme-linked immunosorbent assays(ELISA).All patients need to detect the routine of blood,urine,stool,blood dielectric,blood fat,blood sugar,liver and renal runction as well as electrocardiogram.RESULTS1)Myocardial Acoustic Densitometry:CAI₁ and CAI₂ in the patients with LVH and NLVH were significantly greater than that in the patients of healthy control group (P＜0.01).CVIB₁ and CVIB₂ in the patients with NLVH had no significant difference with healthy control group(P＞0.05),while CVIB₁ and CVIB₂ in the patients with LVH were significantly lower than that in the patients of healthy control group(P＜0.01).CAI₁ and CAI₂ in the patients with LVH were significantly greater than that in the patients with NLVH(P＜0.01),CVIB₁ and CVIB₂ were significantly lower(P＜0.01).2)The concentrations of serum MMP-9 and TIMP-1:The concentration of MMP-9 in the patients with LVH and NLVH were significantly greater than that in the patients of healthy control group(P＜0.01,P＜0.05,respectively),whose concentration of TIMP-1 were also significantly greater(P＜0.01),but the ratios of MMP-9/TIMP-1 in the patients with LVH and NLVH were significantly lower than that in the patients of healthy control group(P＜0.05,P＜0.01,respectively).The concentration of MMP-9 and TIMP-1 in the patients with LVH were significantly greater than that in the patients of NLVH(P＜0.01),but the ratios of MMP-9/TIMP-1 were significantly lower(P＜0.01).3)E/A ratios:E/A ratios in the patients with LVH and NLVH were significantly lower than that in the patients of healthy control group(P＜0.01).E/A ratios in the patients with LVH were significantly lower than NLVH(P＜0.01).4)Ambulatory blood pressure and left ventricular mass index:The 24hSBP,24hDBP,SBP and DBP in the day and night of LVH and NLVH were significantly higher than that in the patients of healthy control group(P＜0.01).And the indicatrix had significant difference between the patients with LVH and NLVH(P＜0.01).Left ventricular mass index in the patients with LVH and NLVH were significantly higher than healthy control group(P＜0.01),and the indicatrix in the patients with LVH were significantly higher than that in NLVH(P＜0.01).5)The relationship between myocardial acoustic densitometry and the concentrations of serum MMP-9,TIMP-1:The concentration of MMP-9 in the patients with LVH was positively related with CAI₁ and CAI₂(P＜0.01),which was inversely related with CVIB₁ and CVIB₂(P＜0.01).The concentration of TIMP-1 in the patients with LVH was positively related with CAI₁ and CAI₂(P＜0.01).6)The relationship between myocardial acoustic densitometry and left ventricular diastolic function:E/A ratios were inversely related with CAI₁ and CAI₂(P＜0.01), which were positively related with CVIB₁,CVIB₂(P＜0.01).7)The relationship between left ventricular diastolic function and the concentrations of serum MMP-9,TIMP-1:E/A ratios were inversely related with the concentration of TIMP-1(P＜0.01),which were positively related with LVMI.There were no significant correlation between E/A ratios and MMP-9 or MMP-9/TIMP-1 ratios.8)The relationship between ambulatory blood pressure and LVMI:The associativity between LVMI and SBP,DBP in the night was more closer than in the day,SBP was closer than DBP.CONCLUSION1)The concentration of MMP-9 and TIMP-1 was positively related with CAI₁,CAI₂,which was inversely related with CVIB₁,CVIB₂.Both myocardial acoustic densitometry parameters and the concentrations of serum MMP-9 and TIMP-1 may be potentially used for evaluation of severity of myocardial fibrosis. 2)E/A ratios were inversely related with CAI₁ and CAI₂,which was positively related with CVIB₁,CVIB₂.Myocardial acoustic densitometry parameters may be potentially used for evaluation of left ventricular diastolic function.3)The concentrations of serum TIMP-1 were significantly related with left ventricular diastolic function and LVMI.4)The associativity between LVMI and SBP,DBP in the night was more closer than in the day,SBP was closer than DBP.