Tanaka Hideji, Oki Takashi, Tabata Tomotsugu, Yamada Hirotsugu, Harada Kenji, Kimura Eriko, Oishi Yoshifumi, Ishimoto Takeo, Ito Susumu
Department of Digestive and Cardiovascular Medicine, School of Medicine, The University of Tokushima, Japan.
J Card Fail. 2004 Oct;10(5):412-20. doi: 10.1016/j.cardfail.2004.01.007.
Angiotensin II receptor antagonists have recently been accepted as antihypertensive therapy. Tissue Doppler imaging (TDI) has been developed as a noninvasive tool to assess quantitatively regional myocardial motion abnormalities. This study was designed to determine whether our newly developed technique of color-coded TDI may be a useful means of quantifying the improvement in regional left ventricular (LV) myocardial contractility and relaxation after treatment with losartan in patients with hypertension.
Losartan (50 to 100 mg) was administered for 6 months to 37 previously untreated patients with essential hypertension. Averaged myocardial velocity profiles (MVPs) for color-coded TDI were recorded in the ventricular septum and LV posterior wall before and after treatment. Peak myocardial velocities and peak myocardial velocity gradients (MVGs) in the LV walls were determined during systole and early diastole. The plasma concentration of transforming growth factor (TGF)-beta1 also was measured in all patients. Blood pressure and plasma TGF-beta1 level decreased after initiation of losartan therapy. The LV mass index and LV meridional end-systolic wall stress also decreased after treatment with losartan. LV geometry changed from a pattern consistent with concentric hypertrophy to normal geometry in 10 patients and to a pattern consistent with concentric remodeling in 5 patients, and from concentric remodeling to normal geometry in 5 patients after treatment with losartan. The ratio of early to late diastolic filling for the transmitral flow velocity increased after losartan treatment. The peak systolic and early diastolic myocardial velocities and MVGs in the ventricular septum and LV posterior wall increased after treatment with losartan, although the values 6 months after treatment with losartan were still lower than those in normal individuals. There were good correlations between changes in plasma TGF-beta1 level and changes in systolic and early diastolic MVGs 6 months after losartan. However, there were no significant correlations between changes in the systolic blood pressure and LV end-systolic wall stress and changes in the TDI parameters.
Losartan improves regional LV function in patients with hypertension. Our newly developed averaged MVP and MVG measurements may be useful for accurately evaluating regional LV myocardial contractility and relaxation in these patients.
血管紧张素II受体拮抗剂最近已被认可为抗高血压治疗药物。组织多普勒成像（TDI）已发展成为一种无创工具，用于定量评估局部心肌运动异常。本研究旨在确定我们新开发的彩色编码TDI技术是否可能是一种有用的方法，用于量化高血压患者接受氯沙坦治疗后局部左心室（LV）心肌收缩性和舒张性的改善情况。
对37例既往未接受治疗的原发性高血压患者给予氯沙坦（50至100mg）治疗6个月。在治疗前后记录室间隔和左心室后壁彩色编码TDI的平均心肌速度曲线（MVPs）。在收缩期和舒张早期测定左心室壁的心肌峰值速度和心肌峰值速度梯度（MVGs）。还对所有患者测量了转化生长因子（TGF）-β1的血浆浓度。氯沙坦治疗开始后血压和血浆TGF-β1水平降低。氯沙坦治疗后左心室质量指数和左心室子午线收缩末期壁应力也降低。氯沙坦治疗后，10例患者的左心室几何形状从与同心性肥厚一致的模式变为正常几何形状，5例患者变为与同心性重构一致的模式，5例患者从同心性重构变为正常几何形状。氯沙坦治疗后二尖瓣血流速度的舒张早期与晚期充盈比值增加。氯沙坦治疗后室间隔和左心室后壁的收缩期和舒张早期心肌峰值速度及MVGs增加，尽管氯沙坦治疗6个月后的数值仍低于正常个体。氯沙坦治疗6个月后，血浆TGF-β1水平的变化与收缩期和舒张早期MVGs的变化之间存在良好的相关性。然而，收缩压和左心室收缩末期壁应力的变化与TDI参数的变化之间无显著相关性。
氯沙坦可改善高血压患者的局部左心室功能。我们新开发的平均MVP和MVG测量方法可能有助于准确评估这些患者的局部左心室心肌收缩性和舒张性。
