Original Researchs

DOI: http://doi.org/10.31928/2305-3127-2018.1.2531

Echocardiography indicators in patients with atherosclerosis of peripheral arteries of the lower extremities dependent on T(–786)C polymorphism of the endothelial nitric oxide synthase gene promoter

V.I. Tseluyko ¹, O.D. Yarova ^{1, 2}

¹ Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
² Sumy Regional Cardiology Dispanser, Sumy, Ukraine

The aim – to evaluate the peculiarities of echocardiographic parameters in patients with peripheral artery atherosclerosis of the lower extremities (PAALE), depending on the type of T(–786)C polymorphism of the promoter eNOs gene.

Materials and methods. 100 male patients with PAALE were examined, average age 60.7 ± 0.9 years old. The average age of the disease manifestation is 53.76 ± 0.67 years. Patients were divided into two clinical groups: group I – 63 (63 %) men without coronary heart disease, group II – 37 (37 %) patients with CHD. Doppler ultrasound examination of the lower extremities and carotid arteries (CA), transthoracic echocardiography (EchoCG), ECG Holter monitoring and genetic analysis using polymerase chain reaction were performed.

Results. 54 patients had signs of left ventricular myocardial hypertrophy (LVMH), while in the 2nd group the patients with C allele (p = 0.02) were dominant. Signs of remodeling of left ventricular myocardium (LVM) with an increase of thickness wall ratio (PTS) had 62 patients: in group I 41 (41 %) people (genotype T/T 41.5 %, C/T – 19.5 %, C/C – 39 %), in the second group – 21 (21 %) (genotypes 9.5 %, 42.9 % and 47.6 % respectively); among patients in the second group C allele was more likely to be present (p = 0.048). Systolic and diastolic dysfunction of the left ventricle myocardium were significantly more common in patients with coronary heart disease (p = 0.046; χ² = 3.95 and p = 0.02; χ² = 5.41 respectively). Correlation analysis revealed a direct connection between left ventricular (LV) systolic dysfunction and the early age of the PAALE manifestation (p = 0.00001), with presence of CHD (p = 0.005). Diastolic dysfunction in patients with the second group was associated with a history of cardiovascular disease (CVD) (p = 0.003) and arterial hypertension (AG) (p = 0.03). The presence of diabetes mellitus type 2 is associated with increased size of the left atrium (LA) (p = 0.049) and the right atrium (RA) (p = 0.02) and left ventricle end-diastolic diameter (p = 0.01), systolic dysfunction (p = 0.03), and with hereditary coronary heart disease (p = 0.02). Genetic analysis has shown that among patients with diabetes mellitus of type 2 carriers of C allele are predominated (p = 0.01).

Conclusions. Among the patients with PAALE combined with CHD, the presence of the C allele the T(–786)C polymorphism of the eNOs promoter gene is associated with systolic and diastolic LV dysfunction and signs of LV remodeling. Diastolic dysfunction is associated hypertension hereditary coronary heart disease. Independent of CHD, diabetes mellitus type 2 is associated with changes of several EchoCG parameters, hereditary coronary heart disease and C allele genotype.

Key words: peripheral artery atherosclerosis of the lower extremities, endothelial NO-synthase gene, polymorphism, echocardiography.