动脉僵硬度和心电图诊断的左心室肥厚与左心室舒张功能障碍的关系。
Association of arterial stiffness and electrocardiography-determined left ventricular hypertrophy with left ventricular diastolic dysfunction.
机构信息
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
PLoS One. 2012;7(11):e49100. doi: 10.1371/journal.pone.0049100. Epub 2012 Nov 7.
OBJECTIVES
Increased arterial stiffness is associated with left ventricular diastolic dysfunction (LVDD), but this association may be influenced by left ventricular (LV) performance. Left ventricular hypertrophy (LVH) is not only a significant determinant of LV performance, but is also correlated with LVDD. This study is designed to compare LV diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV) and electrocardiography (ECG)-determined LVH and to assess whether increased baPWV and ECG-determined LVH are independently associated with LVDD.
METHODS
This cross-sectional study enrolled 270 patients and classified them into four groups according to the median value of baPWV and with/without ECG-determined LVH. The baPWV was measured using an ABI-form device. ECG-determined LVH was defined by Sokolow-Lyon criterion. LVDD was defined as impaired relaxation, pseudonormal, and restrictive mitral inflow patterns. Groups 1, 2, 3, and 4 were patients with lower baPWV and without ECG-determined LVH, lower baPWV but with ECG-determined LVH, higher baPWV but without ECG-determined LVH, and higher baPWV and with ECG-determined LVH respectively.
RESULTS
Early diastolic mitral velocity (Ea) was gradually decreased from group 1 to group 4 (p≦0.027). Patients in group 4 had the highest prevalence of LVDD (all p<0.001). After multivariate analysis, both baPWV and ECG-determined LVH were independent determinants of Ea (β = -0.02, P<0.001; β = -1.77, P<0.001 respectively) and LVDD (odds ratio = 1.02, P = 0.011 and odds ratio = 3.53, P = 0.013 respectively).
CONCLUSION
Our study showed the group with higher baPWV and ECG-determined LVH had the lowest Ea and highest prevalence of LVDD. In addition, both baPWV and ECG-determined LVH were independently associated with Ea and LVDD. Hence, assessment of arterial stiffness by baPWV and LVH by ECG may be useful in identifying the high risk group of LVDD.
目的
动脉僵硬度的增加与左心室舒张功能障碍（LVDD）有关，但这种关联可能受左心室（LV）功能的影响。左心室肥厚（LVH）不仅是 LV 功能的重要决定因素，而且与 LVDD 相关。本研究旨在比较根据肱踝脉搏波速度（baPWV）和心电图（ECG）确定的 LVH 分组的 LV 舒张功能，并评估增加的 baPWV 和 ECG 确定的 LVH 是否与 LVDD 独立相关。
方法
这项横断面研究纳入了 270 名患者，并根据 baPWV 的中位数和有无 ECG 确定的 LVH 将他们分为四组。baPWV 使用 ABI 形式的设备进行测量。ECG 确定的 LVH 由 Sokolow-Lyon 标准定义。LVDD 定义为松弛受损、假正常和限制性二尖瓣流入模式。第 1、2、3 和 4 组分别为 baPWV 较低且无 ECG 确定的 LVH、baPWV 较低但有 ECG 确定的 LVH、baPWV 较高但无 ECG 确定的 LVH 和 baPWV 较高且有 ECG 确定的 LVH 的患者。
结果
从第 1 组到第 4 组，早期舒张期二尖瓣速度（Ea）逐渐降低（p≦0.027）。第 4 组患者的 LVDD 患病率最高（均 p<0.001）。多变量分析后，baPWV 和 ECG 确定的 LVH 均为 Ea 的独立决定因素（β = -0.02，P<0.001；β = -1.77，P<0.001）和 LVDD（比值比 = 1.02，P = 0.011 和比值比 = 3.53，P = 0.013）。
结论
我们的研究表明，baPWV 和 ECG 确定的 LVH 较高的组 Ea 最低，LVDD 的患病率最高。此外，baPWV 和 ECG 确定的 LVH 均与 Ea 和 LVDD 独立相关。因此，baPWV 评估动脉僵硬度和 ECG 评估 LVH 可能有助于识别 LVDD 的高危人群。
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