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


CONCLUSIONS
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.
Pulmonary Hypertension Working Group, Clinic and Policlinic of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland. Leonardo.Glutz@gmx.ch
Leonardo
L
Glutz von Blotzheim
Felix C
FC
Tanner
Georg
G
Noll
Matthias
M
Brock
Manuel
M
Fischler
Jürg
J
Hafner
Rudolf
R
Speich
Silvia
S
Ulrich
Lars C
LC
Huber
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007871:Leg Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies