Istituto di Fisiologia Clinica, Fondazione G Monasterio, Pisa, Italy.
Heart. 2011 Aug;97(15):1257-61. doi: 10.1136/hrt.2010.221259. Epub 2011 May 31.
Consistent evidence shows an impact of systemic haemodynamic overload on the right ventricle, but its functional and structural consequences have received scarce attention for several reasons including the difficult application of conventional imaging techniques due to the complex shape and orientation of that cardiac chamber.
To evaluate whether mild to moderate, uncomplicated hypertension associates with abnormal right ventricular structure and function and how those changes relate to homologous changes in the left ventricle. Data were acquired by steady-state free-precession cardiac MRI, the state of the art tool for the morphological and functional evaluation of the right ventricle.
Twenty-five (12 women) uncomplicated, untreated, essential hypertensive patients were compared with 24 (13 women) sedentary normotensive controls of comparable age. Wall thickness, indexed ventricular mass, end-diastolic volumes, early peak filling rate, a correlate of diastolic relaxation, and ejection fraction were measured at both ventricles. Remodelling index, the ratio of ventricular mass to end-diastolic volume, was used as an index of concentricity.
Right ventricular mass index, ventricular wall thickness and remodelling index were greater in hypertensive subjects and associated with reduced peak filling rate, a pattern consistent with concentric right ventricular remodelling. In the hypertensive group, positive, highly significant biventricular correlations existed between indexed mass, early peak filling rate and ejection fraction.
Systemic hypertension associates with concentric right ventricular remodelling and impaired diastolic function, confirming that the unstressed ventricle is not immune to the effects of systemic hypertension. Structural and functional right ventricular adaptation to systemic hypertension tends to parallel the homologous modifications induced by systemic haemodynamic overload on the left ventricle.
一致的证据表明，全身血流动力学过载对右心室有影响，但由于该心腔的复杂形状和方向，常规成像技术难以应用等多种原因，其功能和结构后果受到的关注较少。
评估轻度至中度、不复杂的高血压是否与右心室结构和功能的异常相关，以及这些变化与左心室同源变化的关系。通过稳态自由进动心脏 MRI 获得数据，这是评估右心室形态和功能的最新工具。
将 25 名（12 名女性）未经治疗的原发性高血压患者与 24 名（13 名女性）久坐的血压正常对照者进行比较，这些对照者的年龄相仿。测量左右心室的室壁厚度、指数化心室质量、舒张末期容积、早期峰值充盈率（舒张功能的一个相关指标）和射血分数。心室质量与舒张末期容积的比值被用作同心性的指标。
高血压患者的右心室质量指数、室壁厚度和重塑指数增加，与峰值充盈率降低有关，这与右心室同心性重塑的模式一致。在高血压组中，左右心室的指数化质量、早期峰值充盈率和射血分数之间存在显著的正相关。
高血压与右心室同心性重塑和舒张功能障碍相关，证实未受压力的心室不能免受系统性高血压的影响。右心室对系统性高血压的结构和功能适应倾向于与系统性血流动力学过载对左心室产生的同源改变平行。
