Dewey Frederick E, Rosenthal David, Murphy Daniel J, Froelicher Victor F, Ashley Euan A
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Circulation. 2008 Apr 29;117(17):2279-87. doi: 10.1161/CIRCULATIONAHA.107.736785.
Extensive evidence is available that cardiovascular structure and function, along with other biological properties that span the range of organism size and speciation, scale with body size. Although appreciation of such factors is commonplace in pediatrics, cardiovascular measurements in the adult population, with similarly wide variation in body size, are rarely corrected for body size. In this review, we describe the critical role of body size measurements in cardiovascular medicine. Using examples, we illustrate the confounding effects of body size. Current cardiovascular scaling practices are reviewed, as are limitations and alternative relationships between body and cardiovascular dimensions. The experimental evidence, theoretical basis, and clinical application of scaling of various functional parameters are presented. Appropriately scaled parameters aid diagnostic and therapeutic decision making in specific disease states such as hypertrophic cardiomyopathy and congestive heart failure. Large-scale studies in clinical populations are needed to define normative relationships for this purpose. Lack of appropriate consideration of body size in the evaluation of cardiovascular structure and function may adversely affect recognition and treatment of cardiovascular disease states in the adult patient.
有大量证据表明，心血管结构和功能以及其他跨越生物体大小和物种形成范围的生物学特性会随体型而变化。尽管在儿科领域对这些因素的认识很普遍，但在成年人群中，体型差异同样很大，心血管测量很少因体型而进行校正。在本综述中，我们描述了体型测量在心血管医学中的关键作用。通过实例，我们阐述了体型的混杂效应。回顾了当前心血管缩放的实践方法，以及体型与心血管维度之间的局限性和替代关系。介绍了各种功能参数缩放的实验证据、理论基础和临床应用。适当缩放的参数有助于在肥厚型心肌病和充血性心力衰竭等特定疾病状态下进行诊断和治疗决策。为此，需要在临床人群中开展大规模研究来确定规范关系。在评估心血管结构和功能时，若缺乏对体型的适当考虑，可能会对成年患者心血管疾病状态的识别和治疗产生不利影响。
