Roul G, Bareiss P, Germain P, Cuny C, Arbogast R, Kieny J R, Facello A, Mossard J M, Sacrez A
Service de cardiologie, hôpital de Hautepierre, CHRU de Strasbourg.
Arch Mal Coeur Vaiss. 1990 Jan;83(1):37-43.
The first stigmata of left ventricular involvement in hypertension are changes in diastolic filling. Early detection of these abnormalities is important as some antihypertensive agents may have beneficial effects on left ventricular distensibility and filling, in addition to lowering the blood pressure. This study compares parameters of left ventricular filling recorded by pulsed Doppler echocardiography in 44 treated hypertensives (average blood pressure: 157 +/- 20/93 +/- 12 mmHg) without any other coronary risk factors with 33 age-matched (52 +/- 13 years and 48 +/- 13 years) control normotensive subjects (average blood pressure: 130 +/- 11/80 +/- 7 mmHg). The main findings were an increase of the peak. A wave velocity after atrial contraction and of the A/E ratio in the hypertensive group (66 +/- 16 cm/s vs 53 +/- 14 cm/s, p less than 0.05 and 0.99 +/- 0.34 vs 0.78 +/- 0.24, p less than 0.05, respectively). These changes were more pronounced in patients with left ventricular hypertrophy. The rapid filling phase was unchanged (maximum E wave velocity = 68 +/- 18 cm/s vs 70 +/- 14 cm/s). The influence of age on peak A wave velocity and A/E ratio was obvious in control subjects and hypertensives without left ventricular hypertrophy r = 0.80; p less than 0.05). The age factor was not significant in the presence of left ventricular hypertrophy (r = 0.18). A weak linear correlation was observed between the peak A wave velocity, diastolic septal thickness (r = 0.44; p = 0.04) and left ventricular mass (r = 0.44; p = 0.05) in hypertensive patients with left ventricular hypertrophy.
高血压患者左心室受累的首个体征是舒张期充盈改变。早期发现这些异常很重要，因为一些抗高血压药物除了能降低血压外，还可能对左心室扩张性和充盈有有益影响。本研究比较了44例接受治疗的高血压患者（平均血压：157±20/93±12 mmHg），这些患者无任何其他冠心病危险因素，与33例年龄匹配（分别为52±13岁和48±13岁）的血压正常对照者（平均血压：130±11/80±7 mmHg），通过脉冲多普勒超声心动图记录的左心室充盈参数。主要发现是高血压组心房收缩后A波峰值速度和A/E比值增加（分别为66±16 cm/s对53±14 cm/s，p<0.05；0.99±0.34对0.78±0.24，p<0.05）。这些变化在左心室肥厚患者中更明显。快速充盈期未改变（最大E波速度 = 68±18 cm/s对70±14 cm/s）。年龄对对照组和无左心室肥厚的高血压患者的A波峰值速度和A/E比值影响明显（r = 0.80；p<0.05）。在存在左心室肥厚时年龄因素不显著（r = 0.18）。在有左心室肥厚的高血压患者中，观察到A波峰值速度与舒张期室间隔厚度（r = 0.44；p = 0.04）和左心室质量（r = 0.44；p = 0.05）之间存在弱线性相关性。
