STATUS OF DIASTOLIC FUNCTION OF LEFT VENTRICLE IN HYPERTENSIVE MEN WITH ANDROGEN DEFICIENCY

The investigation of sexual dimorphism in the development and progression of cardiovascular diseases remains relevant. Close attention of many researchers is paying 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 diastolic dysfunction (LV DD), but the echocardiographic parameters of LV DD in men with hypertension in the presence of androgen deficiency remain unclear. The aim of this study was to investigate the diastolic function of the left ventricle in hypertensive men depending on the level of total and free testosterone. 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, BMI ≥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 LV was analyzed using the speed parameters of its filling. Indicators of transmitral diastolic blood flow were measured - peaks E and A, their ratio (E/A) and deceleration time. In addition, according to TDI, the velocity of the early diastolic motion of the mitral ring in the septal and lateral segments and its mean value were also estimated. To determine the pressure of LV filling, index E/E' was used. Based on the laboratory data, 16 men with a lower total testosterone level were included into 1st group, and 22 hypertensive patients with normal total testosterone level without clinical signs of androgen deficiency formed the second group. Patients did not differ significantly in their age, body mass index (BMI), heart rate, and tobacco smoking status. No statistically significant differences between the patients of both groups were revealed with respect to their LV systolic function. Using the analysis of TDI-derived data, the average E' was significantly lower (0.07 m/s vs. 0,10 m/s in 2nd group (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 velocity of the mitral ring was significantly lower, while the lateral one did not differ significantly. The proportion of patients with an E/E' ratio of more than 15 in the first group was higher than in the group 2 (19.7% vs. 4.5%). А significant increase in E/E' was more frequently observed at a free testosterone concentration of less than 7 pg/ml. Statistically significant correlations 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.