Mayet Jamil, Ariff Ben, Wasan Balvinder, Chapman Neil, Shahi Manjit, Senior Roxy, Foale Rodney A, Thom Simon A McG
Department of Cardiology, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK.
Int J Cardiol. 2002 Dec;86(2-3):233-8. doi: 10.1016/s0167-5273(02)00299-1.
Patients with pathological left ventricular hypertrophy have depressed midwall systolic shortening in spite of normal indices of left ventricular chamber function and a reduced midwall function has been observed to be an independent predictor of cardiovascular risk. Whether midwall shortening is depressed in physiological hypertrophy is unknown.
Forty-two subjects, 27 athletes and 15 age- and sex-matched normal control subjects (group 1) were studied. The athletes were divided into those with eccentric hypertrophy (group 2) and those with concentric hypertrophy (group 3). Systolic left ventricular function was assessed at the midwall and endocardium using two-dimensional echocardiography in all subjects.
Left ventricular mass index was significantly greater in both athletic groups than in controls (group 1, 101+/-5.8 g/m(2), group 2, 141+/-11.1*, group 3, 155+/-5.8*; P<0.01 compared with group 1). Left ventricular systolic function assessed at the endocardium was similar among all three groups (ejection fraction: group 1, 66.2+/-2.38, group 2, 66.8+/-1.44, group 3, 63.7+/-1.66%; endocardial fractional shortening: group 1, 37.1+/-1.71, group 2, 37.6+/-1.13, group 3, 35.1+/-1.25%). However, fractional shortening at the midwall was reduced in the concentric hypertrophy athletes compared with the other two groups (midwall fractional shortening: group 1, 21.9+/-1.1, group 2, 21.9+/-0.86, group 3, 18.4+/-0.96%; P<0.05 compared with groups 1 and 2).
Subjects with physiological concentric hypertrophy have depressed midwall fractional shortening. This suggests that the observed discrepancy between midwall and endocardial shortening in patients with left ventricular hypertrophy is likely to be a function of the geometry and not necessarily a reflection of pathology within the myocardium.
病理性左心室肥厚患者尽管左心室腔功能指标正常，但室壁中层收缩期缩短功能仍降低，且已观察到室壁中层功能降低是心血管风险的独立预测因素。生理性肥厚时室壁中层缩短功能是否降低尚不清楚。
研究了42名受试者，其中27名运动员和15名年龄及性别匹配的正常对照者（第1组）。运动员被分为离心性肥厚组（第2组）和向心性肥厚组（第3组）。所有受试者均使用二维超声心动图在室壁中层和心内膜评估左心室收缩功能。
两个运动员组的左心室质量指数均显著高于对照组（第1组，101±5.8g/m²，第2组，141±11.1*，第3组，155±5.8*；与第1组相比，P<0.01）。三组在心内膜评估的左心室收缩功能相似（射血分数：第1组，66.2±2.38，第2组，66.8±1.44，第3组，63.7±1.66%；心内膜缩短分数：第1组，37.1±1.71，第2组，37.6±1.13，第3组，35.1±1.25%）。然而，与其他两组相比，向心性肥厚运动员的室壁中层缩短分数降低（室壁中层缩短分数：第1组，21.9±1.1，第2组，21.9±0.86，第3组，18.4±0.96%；与第1组和第2组相比，P<0.05）。
生理性向心性肥厚受试者的室壁中层缩短分数降低。这表明，在左心室肥厚患者中观察到的室壁中层和心内膜缩短之间的差异可能是几何形状的作用，而不一定反映心肌内的病理情况。
