高血压伴左心室肥厚患者的无创性肱踝脉搏波速度。

Noninvasive brachial-ankle pulse wave velocity in hypertensive patients with left ventricular hypertrophy.

机构信息

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea.

出版信息

Am J Hypertens. 2010 Mar;23(3):269-74. doi: 10.1038/ajh.2009.243. Epub 2009 Dec 10.

DOI:10.1038/ajh.2009.243

PMID:20010700

Abstract

BACKGROUND

The elevation of left ventricular filling pressure (LVFP) could be an important prognostic factor in patients with hypertension. We hypothesized that noninvasive brachial-ankle pulse wave velocity (baPWV) is associated with increased LVFP in hypertensive patients with LV hypertrophy (LVH).

METHODS

We enrolled patients with well-controlled hypertension for more than 1 year with LV ejection fraction (LVEF) > or = 55%, and LVH. The relationship between Doppler echocardiographic parameters of LVFP and baPWV with B-type natriuretic peptide (BNP) was also evaluated.

RESULTS

A total of 62 patients were enrolled (31 patients with E/E(a) >15 and 31 patients with E/Ea < or = 15) and the baPWV of the E/Ea >15 group was significantly increased compared to the E/Ea < or = 15 group (1,664.3 +/- 270.5 vs. 1,381.9 +/- 159.1 cm/s, P < 0.01). The baPWV showed better correlation with E/Ea (r = 0.69, P < 0.01) than the BNP (r = 0.47, P < 0.01). A multivariate linear regression model showed that only baPWV was significantly correlated with E/E(a), and that the association was independent of other factors. The area under the receiver-operating characteristic (ROC) curve of baPWV for the detection of elevated LVFP (E/Ea >15) was 0.79 (P < 0.01) and the optimal cutoff point of 1,440 cm/s produced 75% sensitivity and 62% specificity (the positive and negative predictive values were 68 and 71%, respectively).

CONCLUSIONS

In this study, we have demonstrated that elevated baPWV is associated with noninvasive markers of increased LVFP in hypertensive LVH patients with preserved LV systolic function.

摘要

背景

左心室充盈压（LVFP）升高可能是高血压患者的一个重要预后因素。我们假设，在左心室收缩功能正常（LVEF≥55%）且存在左心室肥厚（LVH）的高血压患者中，无创肱踝脉搏波速度（baPWV）与 LVFP 升高相关。

方法

我们纳入了血压控制良好（>1 年）、LVEF≥55%且存在 LVH 的高血压患者。还评估了多普勒超声心动图 LVFP 参数与 baPWV 与 B 型利钠肽（BNP）之间的关系。

结果

共纳入 62 例患者（E/Ea>15 者 31 例，E/Ea≤15 者 31 例），E/Ea>15 组的 baPWV 明显高于 E/Ea≤15 组（1664.3±270.5 比 1381.9±159.1 cm/s，P<0.01）。baPWV 与 E/Ea 的相关性优于 BNP（r=0.69，P<0.01；r=0.47，P<0.01）。多变量线性回归模型显示，只有 baPWV 与 E/Ea 显著相关，且这种相关性独立于其他因素。baPWV 检测升高的 LVFP（E/Ea>15）的受试者工作特征（ROC）曲线下面积为 0.79（P<0.01），最佳截断值为 1440 cm/s 时，敏感性为 75%，特异性为 62%（阳性预测值和阴性预测值分别为 68%和 71%）。