Pavlopoulos Harry, Grapsa Julia, Stefanadi Ellie, Kamperidis Vasileios, Philippou Elena, Dawson David, Nihoyannopoulos Petros
Cardiology Department, National Heart and Lung Institute (NHLI), Imperial College of Medicine and Technology, Hammersmith Hospital, Du Cane Rd, W12 0HS London, UK.
Eur J Echocardiogr. 2008 Nov;9(6):772-8. doi: 10.1093/ejechocard/jen145. Epub 2008 Apr 29.
To investigate the effects of cardiac remodelling on left ventricular (LV) diastolic function, as evaluated by tissue Doppler and blood-pool indices, with respect to loading as expressed by wall stress. Cardiac remodelling is the major pathophysiological result of increased blood pressure and manifests as changes in the size, shape, and function of the heart.
We evaluated 90 hypertensive patients and 30 healthy volunteers. The hypertensive patients were divided into three groups: (i) HTN-N: normal remodelling (n= 30), (ii) HTN-CR: concentric remodelling (n= 30), and (iii) HTN-CH: concentric hypertrophy (n= 30). Mitral annular early diastolic (Ea) velocities were recorded. Filling pressures (E/Ea), relative wall thickness, LV mass index, DT, isovolumic relaxation time (IVRT), E/A ratio, and longitudinal wall stress (LWS) were also measured. Diastolic dysfunction (DD) was diagnosed based on published criteria. Progressive and increased incidence of DD with advancement of LV remodelling and an increase in LV mass was noted. Wall stress-loading was higher in the HTN-N group and lower in the HTN-CR and HTN-CH groups, despite the more deteriorated diastolic function in the latter groups. DD appeared early, even in the HTN-N group, which had a 36.6% incidence of DD compared to a 13% age-related incidence in the control group (P < 0.05). When the control group was used to define the reference values for septal Ea with the cut-off set as 2SD below the mean, the HTN-N, HTN-CR, and HTN-CH groups had abnormal diastolic function at 16.6, 26.6, and 56.6% incidence rates, respectively. Septal (Ea) was correlated with LVMI (r= -0.55), RWT (r= -0.56), Age (r= -0.52), BMI (r= -0.31), SBP (r= -0.54), PP (r= -0.55), and MAP (r= -0.39), all at P < 0.05. The correlations of blood-pool indices (DT, IVRT, and E/A) with the above parameters were less than that of tissue Doppler imaging (Septal and mean Ea). In a multivariate model, LVMI (beta= -0.25), SBP (beta = -0.26), and age (beta= -0.24) R(2)= 0.49 were found to be independent predictors of DD.
DD appears early in hypertensive disease, before the onset of abnormal remodelling or LV hypertrophy. With progression of the remodelling process and the advance of LVH, diastolic function progressively deteriorates. Tissue Doppler indices are better correlated with clinical and echocardiographic parameters of LV remodelling compared to blood-pool indices.
通过组织多普勒和血池指数评估心脏重构对左心室（LV）舒张功能的影响，并研究其与壁应力所表示的负荷之间的关系。心脏重构是血压升高的主要病理生理结果，表现为心脏大小、形状和功能的改变。
我们评估了90例高血压患者和30名健康志愿者。高血压患者分为三组：（i）HTN-N：正常重构（n = 30），（ii）HTN-CR：向心性重构（n = 30），以及（iii）HTN-CH：向心性肥厚（n = 30）。记录二尖瓣环舒张早期（Ea）速度。还测量了充盈压（E/Ea）、相对壁厚度、左心室质量指数、DT、等容舒张时间（IVRT）、E/A比值和纵向壁应力（LWS）。根据已发表的标准诊断舒张功能障碍（DD）。注意到随着左心室重构的进展以及左心室质量的增加，DD的发生率逐渐升高。尽管后两组的舒张功能更差，但HTN-N组的壁应力负荷更高，而HTN-CR和HTN-CH组的壁应力负荷更低。DD甚至在HTN-N组中也出现得较早，该组DD的发生率为36.6%，而对照组与年龄相关的发生率为13%（P < 0.05）。当以对照组为参考值来定义室间隔Ea的参考值，将截断值设定为低于平均值2个标准差时，HTN-N、HTN-CR和HTN-CH组舒张功能异常的发生率分别为16.6%、26.6%和56.6%。室间隔（Ea）与左心室质量指数（r = -0.55）、相对壁厚度（r = -0.56）、年龄（r = -0.52）、体重指数（r = -0.31）、收缩压（r = -0.54）、脉压（r = -0.55）和平均动脉压（r = -0.39）均相关，P均< 0.05。血池指数（DT、IVRT和E/A）与上述参数的相关性低于组织多普勒成像（室间隔和平均Ea）。在多变量模型中，发现左心室质量指数（β = -0.25）、收缩压（β = -0.26）和年龄（β = -0.24），R(2)= 0.49是DD的独立预测因素。
DD在高血压疾病早期出现，早于异常重构或左心室肥厚的发生。随着重构过程的进展和左心室肥厚的发展，舒张功能逐渐恶化。与血池指数相比，组织多普勒指数与左心室重构的临床和超声心动图参数的相关性更好。
