Aurigemma G P, Williams D, Gaasch W H, Reda D J, Materson B J, Gottdiener J S
Division of Cardiology, University of Massachusetts Medical School, Worcester, USA.
Am J Cardiol. 2001 Mar 15;87(6):732-6. doi: 10.1016/s0002-9149(00)01492-2.
This study assesses and evaluates left ventricular (LV) contractile function after treatment of hypertension, with an emphasis on LV midwall mechanics. Although prior studies have assessed cardiac function after hypertension treatment, none has performed an analysis of LV midwall mechanics. The Veterans Affairs Study of monotherapy in hypertension was a study large enough to permit analysis of midwall mechanics across a wide spectrum of mass changes accompanying hypertension treatment. LV chamber function was assessed by computing fractional shortening at the endocardial surface; LV midwall shortening was used to define myocardial function. Both shortening indexes were related to end-systolic circumferential stress in the entire population by partitioning values of mass and relative wall thickness changes. Two hundred sixty-eight patients were studied at baseline and again after a 1- or 2-year period. In the entire group, there was no significant change in circumferential shortening either at the endocardium (38 +/- 8% at baseline vs 37 +/- 7% at follow up, p = 0.29) or in shortening at the midwall (20 +/- 3% vs 20 +/- 3%, p = 0.53). However, 83 patients had a reduction in relative wall thickness and an increase in midwall shortening. The change in midwall shortening was significantly related to changes in relative wall thickness (r = -0.53, p = 0.0001). Thus, reductions in LV mass associated with antihypertensive therapy are generally not accompanied by a decrement in LV chamber or myocardial function. Improvement in midwall shortening is more closely related to normalization of LV geometry than to reduction in LV mass.
本研究评估高血压治疗后左心室（LV）的收缩功能，重点关注左心室中层力学。尽管先前的研究评估了高血压治疗后的心脏功能，但尚无研究对左心室中层力学进行分析。退伍军人事务部高血压单一疗法研究规模足够大，能够对高血压治疗过程中伴随的广泛质量变化范围内的中层力学进行分析。通过计算心内膜表面的缩短分数来评估左心室腔功能；使用左心室中层缩短来定义心肌功能。通过划分质量和相对壁厚变化的值，在整个人群中，这两个缩短指数均与收缩末期圆周应力相关。在基线时对268名患者进行了研究，并在1年或2年后再次进行研究。在整个组中，心内膜圆周缩短（基线时为38±8%，随访时为37±7%，p = 0.29）或中层缩短（20±3%对20±3%，p = 0.53）均无显著变化。然而，83名患者的相对壁厚减小，中层缩短增加。中层缩短的变化与相对壁厚的变化显著相关（r = -0.53，p = 0.0001）。因此，与抗高血压治疗相关的左心室质量降低通常不会伴有左心室腔或心肌功能的下降。中层缩短的改善与左心室几何形状的正常化比与左心室质量的降低更密切相关。
