Shimizu M, Kuramochi K, Kitazumi H, Kawaguchi T, Niizuma K, Kawano M, Ogata N, Kawano T, Fukawa S, Noro C
Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara.
J Cardiol. 1990;20(1):123-34.
We studied 45 untreated patients with mild to moderate essential hypertension (EH) and 27 normotensive controls to assess the relationship between pulsed Doppler echocardiographic parameters and cardiac function, and the effects of acute changes in preload or afterload on these parameters. The following pulsed Doppler parameters were measured: as left ventricular (LV) inflow parameters, rapid filling peak velocity (R), presystolic peak velocity (A), and A/R; as LV outflow parameters, preejection period (PEP), ejection period (ET), ET/PEP, and peak velocity (PV). These parameters were compared with those relating to cardiac function, such as age, interventricular septal thickness (IVST), LV mass index (LVMI), % fractional shortening (%FS), LV end-systolic wall stress (WS), blood pressure, and heart rate. The changes in preload and afterload were induced by sodium nitroprusside (SNP) or phenylephrine infusion, which caused decreases or increases in the mean blood pressure by approximately 15%. 1. LV inflow parameters: Compared to normals, A and the A/R were higher in the group EH (p less than 0.01). IVST in the group EH correlated with R and the A/R, but LVMI did not correlate with these parameters. In normals, A correlated with %FS and WS, but did not in the group EH. R and the A/R correlated with age in normals, but not in the group EH. 2. LV outflow parameters: There were no significant differences between the two groups. PV in the group EH correlated positively with %FS, and negatively with WS. The ET/PEP in normals correlated with %FS and WS, but not in the group EH. 3. Effects of SNP: Reduction in preload caused a decrease in R and an increase in the A/R in both the groups (p less than 0.01). At the same time, reduction in afterload induced increase in PV. 4. Effects of phenylephrine: An increase in afterload did not change A, R or the A/R, though PV decreased significantly in normals and tended to decrease in the group EH. In summary, though the significance of the pulsed Doppler parameters of the LV was not always the same between the two groups, these parameters may be used to evaluate cardiac function in EH, if we pay attention to the influence of preload and afterload.
我们研究了45例未经治疗的轻至中度原发性高血压（EH）患者和27例血压正常的对照者，以评估脉冲多普勒超声心动图参数与心功能之间的关系，以及前负荷或后负荷的急性变化对这些参数的影响。测量了以下脉冲多普勒参数：作为左心室（LV）流入参数，快速充盈峰值速度（R）、收缩前期峰值速度（A）和A/R；作为LV流出参数，射血前期（PEP）、射血期（ET）、ET/PEP和峰值速度（PV）。将这些参数与心功能相关参数进行比较，如年龄、室间隔厚度（IVST）、左心室质量指数（LVMI）、缩短分数百分比（%FS）、左心室收缩末期壁应力（WS）、血压和心率。通过输注硝普钠（SNP）或去氧肾上腺素诱导前负荷和后负荷的变化，这使平均血压降低或升高约15%。1. LV流入参数：与正常组相比，EH组的A和A/R更高（p<0.01）。EH组的IVST与R和A/R相关，但LVMI与这些参数无关。在正常组中，A与%FS和WS相关，但在EH组中不相关。在正常组中，R和A/R与年龄相关，但在EH组中不相关。2. LV流出参数：两组之间无显著差异。EH组的PV与%FS呈正相关，与WS呈负相关。正常组的ET/PEP与%FS和WS相关，但在EH组中不相关。3. SNP的影响：前负荷降低导致两组的R降低和A/R升高（p<0.01）。同时，后负荷降低导致PV升高。4. 去氧肾上腺素的影响：后负荷增加并未改变A、R或A/R，尽管正常组的PV显著降低，EH组有降低趋势。总之，尽管两组之间LV的脉冲多普勒参数的意义并不总是相同，但如果我们注意前负荷和后负荷的影响，这些参数可用于评估EH患者的心功能。
