Influência da periodontite crônica grave na função ventricular esquerda, marcadores inflamatórios, reatividade microvascular e espessura mediointimal carotídea em pacientes hipertensos e normotensos

Abstract

Epidemiological studies suggest that chronic periodontitis associates with an increased risk of developing cardiovascular disease, whereas both share a link mediated through the inflammatory process. Arterial hypertension is a major risk factor for cardiovascular diseases, and it is believed that periodontal disease may favor its development. The relationship between periodontitis (PD), inflammation and endothelial dysfunction has been studied through biomarkers and assessment of flow-mediated dilation of the brachial artery. Several conditions associated with subclinical inflammation seem to promote subtle changes in left ventricular systolic function, that can be detected by speckle tracking technology coupled with echocardiography. The present study sought to explore, among hypertensive and normotensive individuals, the possible associations between severe chronic PD and microvascular endothelial function, inflammatory markers and left ventricular systolic and diastolic function. The study was carried out at the Rio de Janeiro State University and consisted of a cross-sectional analysis exploring the associations among severe chronic PD, global longitudinal strain, biomarkers and microvascular reactivity, with control for potential confounding factors. In summary, 88 individuals of both sexes ranging from 35 to 60 years old were assessed, among which, there were 50 hypertensives and 38 normotensives. All underwent dental evaluation with a probe bag protocol aimed at identifying periodontitis, laboratory tests (lipid profile, glucose, high-sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor alpha), blood pressure measurement, assessment of microvascular reactivity and echocardiogram using Laser Speckle Contrast Imaging.Mean age was 49.94±7.32 years; 43% were women; 39% non-white. HDLc (mg/dL): G1:50.09±10.61; G2:60.33±12.67; G3:53.26±14.46; G4:48.27±14.46 (p<0.04); Systolic, diastolic, and mean presssure were significantly higher in hypertensives, with p values of, respectively, 0.004, 0.04 and 0.01 regardless of the presence of severe PD; hsCRP (mg/dL) was significantly lower in G4 (p<0.003); Intimal-medial thickness was numerically lower in normotensives:G1: 0.62±0.15; G2:0.61±0.12; G3:0.54±0.09; G4:0.55±0.10; (p<0.08). Cutaneous vascular conductance by Laser speckle contrast imaging did not differ among groups: G1+G3:0.52 G2+G4:0.55 (p=0.41); G1+G2:0.50 G3+G4:0.56 (p=0.10). Global longitudinal strain (%) was also similar among groups; G1: -21.11±2.24 G2:-21± 2.67 G3:-20.80±3.17 G4:-21±2.82 (p=0.94). Severe periodontal disease was not associated with subclinical left ventricular dysfunction, neither in hypertensives nor in normotensives.