Features of diastolic function of the left ventricle in hypertensive men with androgen deficiency
Background. The investigation of sexual dimorphism in the development and progression of cardiovascular diseases remains relevant. Many researchers pay special attention to the role of androgens as potential mediators of cardiovascular risk. The literature describes the association of endogenous testosterone with the development of left ventricular (LV) diastolic dysfunction, but the echocardiographic parameters of the latter in men with hypertension in the presence of androgen deficiency remain unclear. The objective was to study the diastolic function of the left ventricle in hypertensive men depending on the level of total and free testosterone. Materials and methods. The study included 38 patients with established diagnosis of hypertension and 16 healthy men as the control group. History of coronary heart disease, heart failure NYHA III–IV, cardiomyopathy, valve anomaly, primary hypogonadism, diabetes mellitus, body mass index ≥ 30 kg/m2 were considered as exclusion criteria. For all participants, physical examination, evaluation of serum concentrations of total and free testosterone using immunoassay method, transthoracic echocardiography were performed. Diastolic function of the LV was analyzed using the parameters of filling rate. Indicators of transmitral diastolic blood flow were measured — peaks E and A, their ratio (E/A) and deceleration time. In addition, according to tissue Doppler imaging (TDI), early diastolic mitral annular velocity in the septal and lateral segments and its mean value were evaluated. To determine LV filling pressure, E/E’ ratio was used. Based on the laboratory data, 16 men with reduced total testosterone level were included into group 1, and 22 hypertensive patients with normal total testosterone level without clinical signs of androgen deficiency formed group 2. Results. Patients did not differ significantly in their age, body mass index, heart rate, and tobacco smoking status. No statistically significant differences between the patients of both groups were revealed in terms of their LV systolic function. The analysis of TDI-derived data has shown that the average E’ was significantly lower (0.07 vs. 0.10 m/s in group 2 (р < 0.05) and 0.11 m/s in control sample (р < 0.01)), and the average E/E’ value was higher in men with low free testosterone level (9.83 vs. 8.03 in group 2 (p < 0.05) and 6.60 in the control group, p < 0.05), along with the fact that the septal and mean mitral annular velocity was significantly lower, while the lateral one did not differ significantly. The proportion of patients with E/E’ ratio of more than 15 in the first group was higher than in group 2 (19.7 vs. 4.5 %). А significant increase in E/E’ ratio was more frequently observed in free testosterone concentration of less than 7 pg/ml. Statistically significant correlation were found between the level of free testosterone and E’sept (R = 0.62, p < 0.001), and also with E/E’ ratio (R = –0.54, p < 0.001). A positive direct relationship was also found between E’sept and the total testosterone concentration (R = 0.45, p = 0.005), but it was less potent. Conclusions. The degree of LV diastolic dysfunction in men with hypertension correlates with free testosterone concentration and, to a lesser extent, with total testosterone level. Further studies are needed to determine the pathogenetic mechanisms explaining the relationship shown.
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