Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives

Abstract

We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P < .05). In hypertensives, increased PBR was associated with increased cSBP, PWV, and decreased CFR and GLS after adjustment for age, sex, BMI, smoking LV mass, heart rate, hyperlipidemia, and office SBP (P < .05). PBR had an additive value to PWV, CFR, and office SBP for the prediction of abnormal GLS (x² = 2.4-3.8, P for change = .03). Endothelial glycocalyx is impaired in untreated hypertensives and is related to arterial stiffness, coronary, and myocardial dysfunction.

Keywords: arterial stiffness; endothelial glycocalyx; longitudinal strain; pulse wave velocity.

Figure 1

Representative examples of Global longitudinal strain (GLS), pulse wave velocity (PWV), aortic systolic blood pressure (SBPao) and perfused boundary region of sublingual microvessel (PBR) reflecting glycocalyx thickness in a hypertensive patient (A, B, C and D respectively) and a normal subject (E, F, G and H respectively). Echocardiography images show the 4‐chamber, 2‐chamber, and apical long‐axis views with time‐strain curves along with bull's eye plot of the Global Longitudinal Strain (GLS) (A and E). The measured PWV by Complior with the carotid and femoral pulse wave tracings (B and F), the central aortic systolic blood pressure (SBPao) by Arteriograph with the aortic pulse wave tracings (C and G) and the mean PBR values of microvessel ranging from 5 to 30 μm diameter as bars by Glycocheck (D and H) are shown. The hypertensive patient had a GLS of −16.9%, a PWV of 12.7 m/s, central SBP of 147.1 mm Hg, a PBR _5‐25 of 2.3 and PBR _20‐25 of 2.9 μm compared to a control subject with GLS of −21.9%, a PWV of 8.5 m/s, a central SBP of 122.1 mm Hg, a PBR _5‐25 of 1.89 and PBR _20‐25 of 2.09 μm