Palmieri V, Storto G, Arezzi E, Pellegrino T, Mancini M, Di Minno G, Ferrara A L, Cuocolo A, Celentano A
Department of Clinical and Experimental Medicine, Federico II University School of Medicine, Naples, Italy.
J Hum Hypertens. 2005 Dec;19(12):941-50. doi: 10.1038/sj.jhh.1001921.
Left ventricular hypertrophy (LVH) is prognostically relevant, associated with major cardiovascular risk factors and with atherosclerosis. However, whether LVH is independently associated with impaired coronary flow reserve (CFR) and with endothelial dysfunction is disputed. We assessed the relationship of LV mass and systolic function to CFR and endothelial function in new discovered never treated subjects with essential arterial hypertension, but without coronary artery disease or microalbuminuria. LVH, ejection fraction (EF) and stress-corrected midwall shortening (MWS, a measure of myocardial contractility) were assessed by echocardiography. CFR was assessed by single-photon emission computed tomography and dipyridamole infusion. Endothelial function was evaluated by assessing 1-min postischaemic flow-mediated dilatation of the brachial artery (FMD); nitroglycerine-mediated dilatation (NMD) of the same brachial artery was used as measure of nonendothelium-dependent vasodilatation. In approximately 1 year, we enrolled 21 subjects who met stringent inclusion criteria (47+/-10 years old, 26.6+/-2.8 kg/m2, 78% men). Five patients showed LVH. Multivariate analyses showed a significant negative correlation of LV mass index with FMD (beta=-0.61, P<0.05) but not with NMD, neither with CFR. Stress-corrected MWS showed independent correlation with CFR (beta=0.51, P<0.05). Thus, in clinically healthy, new discovered hypertensive subjects, never treated and mostly in the early stage of arterial hypertension, LVH can be associated with endothelial dysfunction while maximal dipyridamole- dependent CFR may be preserved; nevertheless, a cardiac phenotype presenting with tendency to impaired myocardial contractility, assessed by stress-corrected MWS, showed association with lower CFR in the early stage of arterial hypertension.
左心室肥厚（LVH）具有预后相关性，与主要心血管危险因素及动脉粥样硬化相关。然而，LVH是否独立与冠状动脉血流储备（CFR）受损及内皮功能障碍相关仍存在争议。我们评估了新发现的未经治疗的原发性高血压患者（但无冠状动脉疾病或微量白蛋白尿）的左心室质量和收缩功能与CFR及内皮功能的关系。通过超声心动图评估LVH、射血分数（EF）和应力校正的室壁中层缩短（MWS，心肌收缩力的一种测量指标）。通过单光子发射计算机断层扫描和双嘧达莫输注评估CFR。通过评估缺血后1分钟肱动脉血流介导的扩张（FMD）来评价内皮功能；同一肱动脉的硝酸甘油介导的扩张（NMD）用作非内皮依赖性血管舒张的测量指标。在大约1年的时间里，我们纳入了21名符合严格纳入标准的受试者（年龄47±10岁，体重指数26.6±2.8kg/m²，男性占78%）。5例患者出现LVH。多变量分析显示左心室质量指数与FMD呈显著负相关（β=-0.61，P<0.05），但与NMD无关，与CFR也无关。应力校正的MWS与CFR呈独立相关（β=0.51，P<0.05）。因此，在临床健康、新发现的未经治疗且大多处于高血压早期阶段的高血压患者中，LVH可能与内皮功能障碍相关，而最大双嘧达莫依赖性CFR可能得以保留；然而，通过应力校正的MWS评估，表现出心肌收缩力受损倾向的心脏表型在高血压早期与较低的CFR相关。
