Choi Eui-Young, Ha Jong-Won, Yoon Se-Jung, Shim Chi-Young, Seo Hye-Sun, Park Sungha, Ko Young-Guk, Kang Seok-Min, Choi Donghoon, Rim Se-Joong, Jang Yangsoo, Chung Namsik
Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
J Am Soc Echocardiogr. 2008 Mar;21(3):251-6. doi: 10.1016/j.echo.2007.08.005. Epub 2007 Sep 14.
Relative aldosterone excess is associated with endothelial dysfunction and higher incidence of end organ damage. We sought to investigate whether plasma aldosterone-to-renin ratio (ARR) is associated with left ventricular (LV) longitudinal function reserve to exercise in patients with controlled hypertension. In the patients with controlled and uncomplicated hypertension without overt LV hypertrophy, plasma aldosterone concentrations (ng/dL) and renin activities (ng/mL/h) were measured. Then 28 consecutive patients with higher ARR (group II, ARR > or = 30, 55 +/- 10 years) and 56 age- and sex-matched patients with lower ARR (group I, ARR < 30) underwent supine bicycle exercise echocardiography. Despite similar 24-hour blood pressure, LV mass index was significantly higher in group II (91.1 +/- 16.4 vs 101.7 +/- 18.2 g/m(2), P = .008). Early diastolic and systolic mitral annular velocity (E' and S', cm/s) at 50-W exercise was significantly lower in group II compared with group I (9.91 +/- 1.66 vs 8.67 +/- 1.65 cm/s, P = .002; 9.52 +/- 1.71 vs 8.46 +/- 1.79, P = .010, respectively) despite similar resting values. Longitudinal diastolic functional reserve at 25-W and 50-W exercise, defined as DeltaE' (change from resting E', cm/s) of group II was significantly lower than that of group I (2.60 +/- 1.42 vs 1.85 +/- 1.44 cm/s, P = .016; 3.40 +/- 1.48 vs 2.36 +/- 1.43 cm/s, P = .003, respectively). In conclusion, in patients with hypertension without overt LV hypertrophy, increased ARR is associated with increased LV mass, and impaired LV longitudinal functional reserve during exercise.
相对醛固酮增多与内皮功能障碍及终末器官损害的较高发生率相关。我们试图研究血浆醛固酮与肾素比值（ARR）是否与血压得到控制的高血压患者左心室（LV）纵向运动功能储备相关。在血压得到控制且无明显LV肥厚的高血压患者中，测量血浆醛固酮浓度（ng/dL）和肾素活性（ng/mL/h）。然后，28例连续的ARR较高的患者（II组，ARR≥30，年龄55±10岁）和56例年龄及性别匹配的ARR较低的患者（I组，ARR＜30）接受了仰卧位自行车运动超声心动图检查。尽管24小时血压相似，但II组的LV质量指数显著高于I组（91.1±16.4 vs 101.7±18.2 g/m²，P = 0.008）。尽管静息值相似，但II组在50W运动时舒张早期和收缩期二尖瓣环速度（E'和S'，cm/s）显著低于I组（分别为9.91±1.66 vs 8.67±1.65 cm/s，P = 0.002；9.52±1.71 vs 8.46±1.79，P = 0.010）。II组在25W和50W运动时的纵向舒张功能储备，定义为ΔE'（静息E'的变化，cm/s），显著低于I组（分别为2.60±1.42 vs 1.85±1.44 cm/s，P = 0.016；3.40±1.48 vs 2.36±1.43 cm/s，P = 0.003）。总之，在无明显LV肥厚的高血压患者中，ARR升高与LV质量增加以及运动期间LV纵向功能储备受损相关。
