高血压左心室肥厚患者的心电图应变模式与左心室舒张功能： LIFE研究

Electrocardiographic strain pattern and left ventricular diastolic function in hypertensive patients with left ventricular hypertrophy: the LIFE study.

作者信息

Palmieri Vittorio, Okin Peter M, Bella Jonathan N, Wachtell Kristian, Oikarinen Lasse, Gerdts Eva, Boman Kurt, Nieminen Markku S, Dahlöf Björn, Devereux Richard B

机构信息

Weill Medical College of Cornell University, New York , NY 10021, USA.

出版信息

J Hypertens. 2006 Oct;24(10):2079-84. doi: 10.1097/01.hjh.0000244958.85232.06.

DOI:10.1097/01.hjh.0000244958.85232.06

PMID:16957569

Abstract

BACKGROUND

Whether the typical electrocardiographic (ECG) strain pattern (Strain, in leads V5 and/or V6), which is associated with left ventricular hypertrophy (LVH) and LV systolic dysfunction, is independently associated with LV diastolic dysfunction is unknown.

METHODS

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study enrolled hypertensive patients with ECG-LVH, of whom 10% underwent Doppler echocardiography. LV diastolic function measures included peak mitral E and A wave velocities and their ratio (E/A); E wave deceleration time (EDT); atrial filling fraction (AFF); and isovolumic relaxation time (IVRT). Normal filling pattern was defined by E/A < 1 with EDT >or= 150 and <or= 250 ms and IVRT <or= 100 and >or=60 ms; abnormal relaxation by E/A < 1 with EDT > 250 ms or IVRT > 100 ms; pseudonormal filling pattern by E/A >or= 1 associated with IVRT > 100 ms or EDT > 250 ms; restrictive pattern by E/A >or= 1 with IVRT < 100 ms and EDT < 250 ms. A combined index of LV systolic-diastolic function was also computed (isovolumic time/ejection time, modified myocardial performance index). Of LIFE echo substudy participants with all needed ECG and Doppler data (n = 791), 110 (14%) had Strain.

RESULTS

Strain was associated with male gender, African-American race, diabetes, history of coronary heart disease (CHD), higher systolic blood pressure (BP), LV mass and relative wall thickness, and higher prevalences of echo-LV hypertrophy and wall motion abnormalities, and with slower heart rate (all P < 0.05). Age, diastolic BP and LV ejection fraction were similar in patients with or without Strain. Diastolic parameters, and prevalences of different LV filling patterns, did not differ significantly between patients with versus those without Strain (all P > 0.1), but modified myocardial performance index was higher with Strain (P < 0.05). Findings were consistent in multivariate analyses. The association of Strain with higher modified myocardial performance index was no longer statistically significant after accounting for LV systolic function and wall motion abnormalities.

CONCLUSIONS

In hypertensive patients with ECG-LVH, the ECG Strain pattern did not identify independently those with more severe LV diastolic abnormalities.

摘要

背景

与左心室肥厚（LVH）及左心室收缩功能障碍相关的典型心电图（ECG）应变模式（V5和/或V6导联的应变）是否与左心室舒张功能障碍独立相关尚不清楚。

方法

氯沙坦干预降低高血压终点事件（LIFE）研究纳入了患有ECG-LVH的高血压患者，其中10%接受了多普勒超声心动图检查。左心室舒张功能指标包括二尖瓣E峰和A峰峰值速度及其比值（E/A）；E波减速时间（EDT）；心房充盈分数（AFF）；以及等容舒张时间（IVRT）。正常充盈模式定义为E/A<1，EDT≥150且≤250毫秒，IVRT≤100且≥60毫秒；松弛异常为E/A<1，EDT>250毫秒或IVRT>100毫秒；假性正常充盈模式为E/A≥1，伴有IVRT>100毫秒或EDT>250毫秒；限制性模式为E/A≥1，IVRT<100毫秒且EDT<250毫秒。还计算了左心室收缩-舒张功能的综合指数（等容时间/射血时间，改良心肌性能指数）。在LIFE超声心动图亚研究中，具有所有所需ECG和多普勒数据的参与者（n = 791）中，110例（14%）有应变。

结果

应变与男性、非裔美国人种族、糖尿病、冠心病（CHD）病史、较高的收缩压（BP）、左心室质量和相对壁厚度、超声心动图左心室肥厚和室壁运动异常的较高患病率相关，且与心率较慢相关（均P<0.05）。有或无应变的患者年龄、舒张压和左心室射血分数相似。有应变与无应变的患者之间舒张参数及不同左心室充盈模式的患病率无显著差异（均P>0.1），但改良心肌性能指数在有应变的患者中较高（P<0.05）。多变量分析结果一致。在考虑左心室收缩功能和室壁运动异常后，应变与较高改良心肌性能指数的关联不再具有统计学意义。