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Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study


Glutz von Blotzheim, Leonardo; Tanner, Felix; Noll, Georg; Brock, Matthias; Fischler, Manuel; Hafner, Juerg; Speich, Rudolf; Ulrich, Silvia; Huber, Lars C (2012). Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study. Respiratory Research, 13(1):45.

Abstract

BACKGROUND: Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. METHODS: In this case-control-study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. RESULTS: Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8+/-16.9 vs 25.3+/-6.5 mmHg, p=0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p=0.031). No differences were seen in left heart size and function between patients and controls. CONCLUSION: This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension.

BACKGROUND: Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. METHODS: In this case-control-study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. RESULTS: Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8+/-16.9 vs 25.3+/-6.5 mmHg, p=0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p=0.031). No differences were seen in left heart size and function between patients and controls. CONCLUSION: This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Dermatology Clinic
04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:12 Jul 2012 07:04
Last Modified:05 Apr 2016 15:52
Publisher:BioMed Central
ISSN:1465-9921
Publisher DOI:10.1186/1465-9921-13-45
PubMed ID:22686459
Permanent URL: http://doi.org/10.5167/uzh-63304

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