中年腹型肥胖患者心脏和血管早期重构的综合 MRI 分析。

Comprehensive MRI analysis of early cardiac and vascular remodeling in middle-aged patients with abdominal obesity.

机构信息

CHU-Nancy, Department of Radiology, Nancy, France.

出版信息

J Hypertens. 2012 Mar;30(3):567-73. doi: 10.1097/HJH.0b013e32834f6f3f.

DOI:10.1097/HJH.0b013e32834f6f3f

PMID:22227821

Abstract

OBJECTIVES

To determine, using a comprehensive MRI investigation, prevalence and vascular correlates of early left-ventricular concentric remodeling in middle-aged patients with abdominal obesity. Left-ventricular and vascular remodeling are commonly associated with hypertension, but little is known for abdominal obesity patients, a population with definite increase in cardiovascular risk and high rates of further developments of hypertension and of the metabolic syndrome.

METHODS

Seventy middle-aged abdominal obesity patients (56 ± 5 years, 49% women, 69% with body mass index > 30 kg/m), who had no additional cardiovascular risk factor except for untreated stage 1 hypertension (16%), and 40 controls underwent MRI for detecting concentric remodeling (increase in left-ventricular mass/end-diastolic volume ratio) and identifying potential determinants, including arterial compliance indexes [aortic pulse wave velocity and total arterial compliance (TAC)] and total peripheral vascular resistances (TPVRs).

RESULTS

Twenty abdominal obesity patients (29%) had concentric remodeling (concentric remodeling+), whereas 50 did not (concentric remodeling-). Concentric remodeling+ patients were mostly men (85%), they frequently had stage 1 hypertension (45%) and few had left-ventricular hypertrophy (20%). When adjusted for sex, there was a step-by-step decline in TAC between controls (mean ± SEM: 2.10 ± 0.06 ml/mmHg), concentric remodeling- (1.82 ± 0.06 ml/mmHg) and concentric remodeling+ (1.42 ± 0.09 ml/mmHg, P < 0.005 for inter-group comparisons) and TPVRs were lower than controls for concentric remodeling- (14.7 ± 0.5 vs. 16.8 ± 0.5 ml/mmHg, P = 0.005) but not for concentric remodeling+ (17.5 ± 0.7 mmHg/min per l).

CONCLUSIONS

Concentric remodeling is frequently documented by MRI in the middle-aged men with abdominal obesity and in association with a decrease in TAC no longer counter-balanced by a decrease in TPVR, suggesting a remodeling from proximal to peripheral vasculature.

摘要

目的

通过全面的 MRI 检查，确定中年腹型肥胖患者中左心室早期向心性重构的发生率及其血管相关性。左心室和血管重构通常与高血压相关，但对于腹型肥胖患者，其相关信息知之甚少，该人群心血管风险明显增加，高血压和代谢综合征的发生率也很高。

方法

70 例中年腹型肥胖患者（56±5 岁，49%为女性，69%的患者 BMI>30kg/m²），除未经治疗的 1 期高血压（16%）外，无其他心血管危险因素，以及 40 名对照者接受 MRI 检查，以检测向心性重构（左心室质量/舒张末期容积比增加），并确定潜在的决定因素，包括动脉顺应性指标[主动脉脉搏波速度和总动脉顺应性（TAC）]和总外周血管阻力（TPVR）。

结果

20 例腹型肥胖患者（29%）存在向心性重构（向心性重构+），50 例患者无向心性重构（向心性重构-）。向心性重构+患者多为男性（85%），常患有 1 期高血压（45%），很少有左心室肥厚（20%）。校正性别后，对照组（平均值±SEM：2.10±0.06ml/mmHg）、向心性重构-组（1.82±0.06ml/mmHg）和向心性重构+组（1.42±0.09ml/mmHg）的 TAC 呈逐步下降，TPVR 也低于对照组（向心性重构-组：14.7±0.5vs.16.8±0.5mmHg，P<0.005），但与向心性重构+组无差异（17.5±0.7mmHg/min per l）。