生理性和高血压性向心性肥厚中的室壁中层力学

Midwall mechanics in physiologic and hypertensive concentric hypertrophy.

作者信息

Ballo Piercarlo, Mondillo Sergio, Guerrini Francesco, Barbati Riccardo, Picchi Andrea, Focardi Marta

机构信息

U.O. Cardiologia, Ospedale S. Andrea, via Veneto 197, 19100 La Spezia, Italy.

出版信息

J Am Soc Echocardiogr. 2004 May;17(5):418-27. doi: 10.1016/j.echo.2004.01.011.

DOI:10.1016/j.echo.2004.01.011

PMID:15122180

Abstract

OBJECTIVE

We sought to analyze and compare midwall fractional shortening (mFS), and its relations with circumferential end-systolic stress (cESS) and relative wall thickness (RWT), among subjects with physiologic concentric left ventricular (LV) hypertrophy, patients with hypertension and concentric LV hypertrophy, and control subjects.

METHODS

A total of 51 normotensive athletes and 56 young patients with hypertension and echocardiographic evidence of concentric LV hypertrophy were enrolled. In addition, 49 age- and sex-matched control subjects were recruited. LV cavity size and wall thicknesses, LV mass, RWT, cESS, and mFS were determined by echocardiography.

RESULTS

The 3 groups were similar in age, sex, height, weight, body surface area, LV diameters, and conventional indices of systolic function. LV thicknesses, RWT, LV mass, and LV mass index were similarly increased in the athletes and in the hypertensive group when compared with the control subjects. A similar depression in mFS was observed in both the athletes (22.4 +/- 2.6%) and hypertensive group (22.5 +/- 3.6%) in comparison with the control group (24.5 +/- 2.5%, P =.0003). The depression in mFS was still significant after taking into account the effect of cESS, but was no more evident after indexation of mFS by RWT or LV mass. At regression analysis, the relation between mFS and cESS showed a steeper negative slope in the patients with hypertension than in the other 2 groups.

CONCLUSIONS

MFS is similarly depressed in physiologic and hypertensive concentric LV hypertrophy. The depression is abolished by adjustment for RWT or LV mass, suggesting that geometric factors are the major determinants of midwall performance in both types of concentric LV hypertrophy. However, an impaired response to different values of cESS seems to exist only in hypertensive concentric LV hypertrophy, because increasing levels of cESS may be associated with more evident mFS depression in patients with hypertension than in the athletes and control subjects.

摘要

目的

我们试图分析和比较生理性向心性左心室肥厚患者、高血压合并向心性左心室肥厚患者以及对照组受试者的室壁中层缩短分数（mFS），及其与圆周收缩末期应力（cESS）和相对室壁厚度（RWT）的关系。

方法

共纳入51名血压正常的运动员和56名患有高血压且有向心性左心室肥厚超声心动图证据的年轻患者。此外，招募了49名年龄和性别匹配的对照受试者。通过超声心动图测定左心室腔大小和壁厚度、左心室质量、RWT、cESS和mFS。

结果

三组在年龄、性别、身高、体重、体表面积、左心室直径和收缩功能的传统指标方面相似。与对照组相比，运动员组和高血压组的左心室壁厚度、RWT、左心室质量和左心室质量指数均有相似程度的增加。与对照组（24.5±2.5%，P = 0.0003）相比，运动员组（22.4±2.6%）和高血压组（22.5±3.6%）的mFS均有类似程度的降低。在考虑cESS的影响后，mFS的降低仍然显著，但在mFS经RWT或左心室质量校正后不再明显。在回归分析中，高血压患者中mFS与cESS之间的关系显示出比其他两组更陡峭的负斜率。

结论

生理性和高血压性向心性左心室肥厚中mFS均有类似程度的降低。通过对RWT或左心室质量进行校正后，这种降低被消除，这表明几何因素是两种类型向心性左心室肥厚中室壁中层性能的主要决定因素。然而，似乎只有在高血压性向心性左心室肥厚中存在对不同cESS值的反应受损，因为与运动员和对照组相比，高血压患者中cESS水平升高可能与更明显的mFS降低有关。