Kozakova Michaela, Paterni Marco, Bartolomucci Francesco, Morizzo Carmela, Rossi Giuseppe, Galetta Fabio, Palombo Carlo
Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy.
Am J Hypertens. 2007 Mar;20(3):279-84. doi: 10.1016/j.amjhyper.2006.07.003.
In the hypertensive heart, epicardial arteries are not enlarged, despite increased total coronary flow related to augmented cardiac workload, wall stress, and left ventricular (LV) mass. The aims of this study were to assess the impact of different hemodynamic factors and LV mass on baseline left main coronary artery (LMA) size in hypertensive LV hypertrophy (LVH) and physiologic LVH, used as a pressure-independent model of hypertrophy.
In 104 subjects without coronary disease (26 normotensive subjects without LVH, 15 athletes with physiologic LVH, and 63 untreated hypertensive subjects [28 without and 35 with LVH]), LMA size and coronary flow reserve (CFR) were measured by transesophageal echocardiography, and LV mass, volumes, stroke work, and wall stress were measured by transthoracic echocardiography.
The LMA area in normotensive control subjects, athletes, and hypertensive subjects without and with LVH was 13.2 +/- 4.2, 17.5 +/- 2.9, 10.1 +/- 3.2 and 13.1 +/- 3.9 mm(2). In normotensive control subjects, LMA size increased with body surface area, rate-pressure product, stroke work, and LV mass or wall thickness (r = 0.39, 0.39, 0.47 and 0.67 or 0.62, P < .05-0.01). In athletes with physiologic LVH, LMA area increased with CFR (0.65, P < .01). In the whole hypertensive population, LMA lumen increased with LV mass (r = 0.40, P < .01), and decreased with office systolic blood pressure (r = -0.48, P < .01).
In the hypertensive LVH, baseline LMA area is not increased and is inversely related to office systolic blood pressure. In the physiologic LVH, increase in baseline LMA size seems to reflect effect of high-flow stimuli.
在高血压性心脏中，尽管与增加的心脏工作量、壁应力和左心室（LV）质量相关的总冠状动脉血流量增加，但心外膜动脉并未增大。本研究的目的是评估不同血流动力学因素和LV质量对高血压性左心室肥厚（LVH）和生理性LVH（用作压力非依赖性肥厚模型）中左主干冠状动脉（LMA）基线大小的影响。
在104例无冠心病的受试者中（26例无LVH的血压正常受试者、15例生理性LVH的运动员和63例未经治疗的高血压受试者[28例无LVH和35例有LVH]），通过经食管超声心动图测量LMA大小和冠状动脉血流储备（CFR），并通过经胸超声心动图测量LV质量、容积、每搏功和壁应力。
血压正常的对照受试者、运动员以及无LVH和有LVH的高血压受试者的LMA面积分别为13.2±4.2、17.5±2.9、10.1±3.2和13.1±3.9mm²。在血压正常的对照受试者中，LMA大小随体表面积、心率-血压乘积、每搏功以及LV质量或壁厚增加（r = 0.39、0.39、0.47和0.67或0.62，P <.05 - 0.01）。在生理性LVH的运动员中，LMA面积随CFR增加（0.65，P <.01）。在整个高血压人群中，LMA管腔随LV质量增加（r = 0.40，P <.01），并随诊室收缩压降低（r = -0.48，P <.01）。
在高血压性LVH中，基线LMA面积未增加，且与诊室收缩压呈负相关。在生理性LVH中，基线LMA大小的增加似乎反映了高流量刺激的作用。
