Smalcelj A, Puljević D, Buljević B, Brida V
Clinic for Cardiovascular Diseases, University Hospital Rebro, Zagreb, Croatia.
Coll Antropol. 2000 Jun;24(1):167-83.
In order to study left ventricular hypertrophy patterns in obese hypertensives, we examined 132 patients with essential hypertension by 2D, M-mode and Doppler echocardiography. The patients were classified in four comparable groups, corresponding to the values of Quetelet's body mass index (BMI) and grades of obesity. More obese hypertensives had on average larger left ventricles with thicker walls and larger left atria than less obese, or lean ones. Left ventricular mass increased significantly and progressively with advancing grades of obesity, but relative wall thickness (wall thickness/cavity size ratio) did not diminish. Doppler echocardiography revealed significantly higher prevalence of left ventricular diastolic dysfunction among obese than among lean hypertensives. In the second part of our study, we analyzed the subgroups defined by the severity of hypertension and the age of the patients. The correlation of the indices of left ventricular and left atrial hypertrophy with the BMI values was considerably better in the group of moderate than in the group of mild hypertension. The r values were 0.62 vs. 0.22 for left ventricular mass and 0.64 vs. 0.26 for left atrial dimension. The group of patients with severe hypertension was characterized by left ventricular cavity enlargement in correlation with increasing BMI values, but without corresponding left ventricular wall thickening. So called left ventricular "eccentricity index", as the reverse value of relative wall thickness, correlated well (r = 0.76) with the BMI values. The indices of left ventricular hypertrophy correlated with the BMI values slightly better in middle age groups than in the groups of the youngest (< or = 30 years) or the eldest (> or = 61 years) hypertensives. In conclusion, eccentric left ventricular hypertrophy does not seem to be a distinctive feature of hypertensive heart disease in obesity. There is only some tendency toward the "eccentricity" of left ventricular geometry which becomes more apparent in more severe forms of hypertension, especially in very obese persons.
为研究肥胖高血压患者的左心室肥厚模式，我们采用二维、M型和多普勒超声心动图对132例原发性高血压患者进行了检查。根据体重指数（BMI）值和肥胖等级，将患者分为四个可比组。与肥胖程度较低或体型偏瘦的患者相比，肥胖程度较高的高血压患者平均左心室更大、室壁更厚、左心房更大。随着肥胖等级的升高，左心室质量显著且逐渐增加，但相对室壁厚度（室壁厚度/腔径比值）并未减小。多普勒超声心动图显示，肥胖高血压患者左心室舒张功能障碍的患病率显著高于体型偏瘦的高血压患者。在研究的第二部分，我们分析了根据高血压严重程度和患者年龄定义的亚组。中度高血压组中左心室和左心房肥厚指标与BMI值的相关性明显优于轻度高血压组。左心室质量的r值分别为0.62和0.22，左心房内径的r值分别为0.64和0.26。重度高血压患者组的特征是左心室腔扩大与BMI值增加相关，但左心室壁没有相应增厚。所谓的左心室“偏心指数”，作为相对室壁厚度的倒数，与BMI值相关性良好（r = 0.76）。中年高血压患者组中左心室肥厚指标与BMI值的相关性略优于最年轻（≤30岁）或最年长（≥61岁）高血压患者组。总之，偏心性左心室肥厚似乎不是肥胖高血压性心脏病的独特特征。左心室几何形状仅存在一些“偏心”倾向，在更严重的高血压形式中，尤其是在非常肥胖的人群中更为明显。
