Mehta Sameer K, Rame J Eduardo, Khera Amit, Murphy Sabina A, Canham Russell M, Peshock Ronald M, de Lemos James A, Drazner Mark H
Donald W. Reynolds Cardiovascular Clinical Research Center and Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.
Hypertension. 2007 Jun;49(6):1385-91. doi: 10.1161/HYPERTENSIONAHA.107.087890. Epub 2007 Apr 2.
To elucidate mechanisms by which left ventricular (LV) hypertrophy (LVH) increases the risk of atherosclerotic heart disease, we sought to determine whether LVH is independently associated with coronary artery calcium (CAC) and serum C-reactive protein (CRP) levels in the general population. The Dallas Heart Study is a population-based sample in which 2633 individuals underwent cardiac MRI to measure LV structure, electron beam CT to measure CAC, and measurement of plasma CRP. We used univariate and multivariable analyses to determine whether LV mass and markers of concentric LV hypertrophy or dilation were associated with CAC and CRP. Increasing quartiles of LV mass indexed to fat-free mass, LV wall thickness, and concentricity, but not LV volume, were associated with CAC in both men and women (P<0.001). After adjustment for traditional cardiovascular risk factors and statin use, LV wall thickness and concentricity remained associated with CAC in linear regression (P<0.001 for each). These associations were particularly robust in blacks. LV wall thickness and concentricity were also associated with elevated CRP levels (P=0.001 for both) in gender-stratified univariate analyses, although these associations did not persist in multivariable analysis. In conclusion, concentric LVH is an independent risk factor for subclinical atherosclerosis. LVH is also associated with an inflammatory state as reflected in elevated CRP levels, although this relationship appears to be mediated by comorbid conditions. These data likely explain in part why individuals with LVH are at increased risk for myocardial infarction.
为阐明左心室（LV）肥厚（LVH）增加动脉粥样硬化性心脏病风险的机制，我们试图确定在普通人群中LVH是否与冠状动脉钙化（CAC）及血清C反应蛋白（CRP）水平独立相关。达拉斯心脏研究是一项基于人群的样本研究，其中2633名个体接受了心脏磁共振成像以测量LV结构、电子束CT以测量CAC以及血浆CRP测量。我们使用单变量和多变量分析来确定LV质量以及向心性LV肥厚或扩张的标志物是否与CAC和CRP相关。以去脂体重、LV壁厚度和向心性指数表示的LV质量四分位数增加，但LV容积未增加，在男性和女性中均与CAC相关（P<0.001）。在调整传统心血管危险因素和他汀类药物使用后，LV壁厚度和向心性在线性回归中仍与CAC相关（每项P<0.001）。这些关联在黑人中尤为显著。在按性别分层的单变量分析中，LV壁厚度和向心性也与CRP水平升高相关（两者均P=0.001），尽管这些关联在多变量分析中未持续存在。总之，向心性LVH是亚临床动脉粥样硬化的独立危险因素。LVH也与炎症状态相关，如CRP水平升高所反映的那样，尽管这种关系似乎由合并症介导。这些数据可能部分解释了为什么LVH个体发生心肌梗死的风险增加。
