Palmiero Pasquale, Maiello Maria, Nanda Navin C
A.S.L.BR 1, Health Center, Districtual Cardiology, Brindisi, Italy.
Echocardiography. 2008 Jan;25(1):20-6. doi: 10.1111/j.1540-8175.2007.00564.x.
The correlation between left ventricular (LV) geometry, mass, diastolic function, and midwall fractional shortening (MFS) in hypertensive patients with left ventricular hypertrophy (LVH) is not well established owing to limited diffusion of MFS evaluation. The aim of the study was to evaluate this correlation in 1887 consecutive hypertensive patients, all affected by LVH (mean age 66 years, 924 males), with LV ejection fraction (LVEF) >45% for early detection of ventricular dysfunction rather than LVEF and diastolic function impairment.
All patients underwent M-B mode echocardiography and PW-Doppler evaluation. LV geometry and mass were compared with Doppler-determined mitral flow and tissue velocities. LV geometry was eccentric (E) for 1018 subjects (53.9%) and concentric (C) for 869 (46.1%). There was no difference concerning LV diastolic dysfunction (P: n.s.) between 576 (30.6%) of the ELVH and 368 (19.4%) of the CLVH patients. The following parameters showed significant statistical differences: LV MFS impairment (P < 0.01) between 86 (4.6%) of the ELVH and 177 (9.4%) of the CLVH patients. LV MFS impairment rate was higher in 171 patients without LV diastolic dysfunction (9.1%), than in 92 patients affected (4.9%, P < 0.02). In CLVH patients, a higher prevalence of LV MFS impairment was observed in 143 without LV diastolic dysfunction (7.6%), than in 34 patients affected (1.8%, P < 0.01). In ELVH patients, a lower prevalence of LV MFS impairment was observed in 28 without diastolic dysfunction (1.5%), than in 58 patients affected (3.1%, P < 0,03).
Midwall LV impairment, an independent predictor of cardiac death and morbidity in hypertensive patients, can allow early identification of patients with LV dysfunction even when LVEF or assessment of diastolic function are normal. LV MFS impairment rate is higher in CLVH patients, and even higher when considering only those CLVH patients with no diastolic dysfunction. These results suggest that the ventricular dysfunction with normal LVEF is not always due to diastolic dysfunction, but often to systolic dysfunction as assessed by MFS impairment, an important early sign of ventricular dysfunction in hypertensive patients, even when diastolic function is normal.
由于中壁分数缩短（MFS）评估的普及程度有限，高血压左心室肥厚（LVH）患者的左心室（LV）几何形态、质量、舒张功能与MFS之间的相关性尚未完全明确。本研究旨在评估1887例连续的高血压LVH患者（平均年龄66岁，男性924例）的这种相关性，这些患者的左心室射血分数（LVEF）>45%，以早期检测心室功能障碍，而非LVEF和舒张功能损害。
所有患者均接受M型和B型超声心动图以及脉冲波多普勒评估。将LV几何形态和质量与多普勒测定的二尖瓣血流和组织速度进行比较。1018例受试者（53.9%）的LV几何形态为偏心型（E），869例（46.1%）为同心型（C）。偏心性LVH患者中的576例（30.6%）与同心性LVH患者中的368例（19.4%）在LV舒张功能障碍方面无差异（P：无统计学意义）。以下参数显示出显著的统计学差异：偏心性LVH患者中的86例（4.6%）与同心性LVH患者中的177例（9.4%）在LV MFS损害方面（P<0.01）。171例无LV舒张功能障碍的患者的LV MFS损害率（9.1%）高于92例有舒张功能障碍患者的损害率（4.9%，P<0.02）。在同心性LVH患者中，143例无LV舒张功能障碍患者的LV MFS损害患病率（7.6%）高于34例有舒张功能障碍患者（1.8%，P<0.01）。在偏心性LVH患者中，28例无舒张功能障碍患者的LV MFS损害患病率（1.5%）低于58例有舒张功能障碍患者（3.1%，P<0.03）。
中壁LV损害是高血压患者心脏死亡和发病的独立预测因素，即使LVEF或舒张功能评估正常，也能早期识别LV功能障碍患者。同心性LVH患者的LV MFS损害率更高，仅考虑那些无舒张功能障碍的同心性LVH患者时损害率甚至更高。这些结果表明，LVEF正常的心室功能障碍并非总是由舒张功能障碍引起，而往往是由MFS损害评估的收缩功能障碍所致，MFS损害是高血压患者心室功能障碍的重要早期征象，即使舒张功能正常。
