Zabalgoitia M, Berning J, Koren M J, Støylen A, Nieminen M S, Dahlöf B, Devereux R B
Department of Medicine/Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
Am J Cardiol. 2001 Sep 15;88(6):646-50. doi: 10.1016/s0002-9149(01)01807-0.
Hypertensive patients with left ventricular (LV) hypertrophy have a higher incidence of cardiovascular events than those without it. We hypothesized that a close relation exists between clinical evidence of coronary artery disease (CAD) and alterations in LV structure and function that contribute to their higher risk. Echocardiograms were recorded in 963 hypertensive patients (mean age 66 +/- 7 years, 41% women) with electrocardiographic LV hypertrophy, and divided into 149 with and 814 without clinical (prior myocardial infarction or angina pectoris) or electrocardiographic (Minnesota codes 1.1, 1.2) evidence of CAD. Patients with CAD had larger LV internal dimensions (5.5 +/- 0.6 vs 5.2 +/- 0.5 cm), increased LV mass (136 +/- 31 vs 122 +/- 24 g/m(2), and 62.4 +/- 19.4 vs 55.5 +/- 12.1 g/m(2.7)), lower ejection fraction (58 +/- 10% vs 62 +/- 8%), higher circumferential end-systolic wall stress (cESS) (198 +/- 59 vs 181 +/- 47 kdynes/cm(2), all p <0.001), and higher total peripheral resistances (2,088 +/- 628 vs 1,963 +/- 553 dynes x s x m(2)/cm(3), p = 0.02). Although eccentric LV hypertrophy predominated, the CAD group had a greater prevalence of this geometric pattern than the non-CAD group (56% vs 47%, p <0.02). An index of myocardial oxygen demand per beat--the LV mass x cESS x ejection time--was 20% higher in patients with CAD. In conclusion, clinical evidence of CAD in hypertensive patients with electrocardiographic evidence of LV hypertrophy identifies subjects with structural and functional abnormalities at high risk for cardiovascular events. LV mass. cESS. ejection time, a noninvasive index that parallels myocardial oxygen demand per beat, is especially high in hypertensive patients with CAD.
患有左心室（LV）肥厚的高血压患者发生心血管事件的几率高于未患左心室肥厚的患者。我们推测，冠状动脉疾病（CAD）的临床证据与左心室结构和功能改变之间存在密切关系，而这些改变导致了他们更高的风险。对963例患有心电图左心室肥厚的高血压患者（平均年龄66±7岁，41%为女性）进行了超声心动图检查，并将其分为149例有CAD临床证据（既往心肌梗死或心绞痛）或心电图证据（明尼苏达编码1.1、1.2）的患者和814例无此类证据的患者。CAD患者的左心室内径更大（5.5±0.6 vs 5.2±0.5 cm），左心室质量增加（136±31 vs 122±24 g/m²，以及62.4±19.4 vs 55.5±12.1 g/m².⁷），射血分数更低（58±10% vs 62±8%），圆周收缩末期壁应力（cESS）更高（198±59 vs 181±47 kdynes/cm²，所有p<0.001），总外周阻力更高（2088±628 vs 1963±553 dynes×s×m²/cm³，p = 0.02）。虽然以离心性左心室肥厚为主，但CAD组这种几何模式的患病率高于非CAD组（56% vs 47%，p<0.02）。CAD患者每搏心肌需氧量指标——左心室质量×cESS×射血时间——高出20%。总之，有心电图左心室肥厚证据的高血压患者中CAD的临床证据可识别出有心血管事件高风险的结构和功能异常受试者。左心室质量、cESS、射血时间，这一与每搏心肌需氧量平行的无创指标，在患有CAD的高血压患者中尤其高。
