高血压患者左心室收缩功能与左心室同心性和扩张的关系：氯沙坦干预高血压终点降低研究。

Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study.

机构信息

aDepartment of Medicine, Weill Cornell Medical College, New York, USA bDepartment of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark cDepartment of Clinical Science, University of Bergen dDepartment of Heart Disease, Haukeland University Hospital, Bergen, Norway eDivision of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA fInstitution of Public Health and Clinical Medicine, Umeå University, Medicine Skellefteå, Umeå gDepartment of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden hDepartment of Medicine, Glostrup Hospital, Glostrup, Denmark.

出版信息

J Hypertens. 2013 Oct;31(10):2060-8. doi: 10.1097/HJH.0b013e328362bbd6.

DOI:10.1097/HJH.0b013e328362bbd6

PMID:23838656

Abstract

BACKGROUND

Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients.

METHODS AND RESULTS

Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05).

CONCLUSION

The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.

摘要

背景

左心室肥厚（LVH，左心室质量高）传统上基于左心室相对壁厚度分为向心性或偏心性。我们根据高血压患者的左心室扩张（高左心室舒张末期容积指数和同心性），在新的四组 LVH 分类中评估左心室收缩功能。

方法和结果

洛沙坦干预终点降低高血压（LIFE）超声心动图亚研究中的 939 名参与者在入组时可测量左心室质量。左心室肥厚（LVH，LVM/体表面积男性≥116g/m，女性≥96g/m）患者分为四组；“偏心非扩张型”（正常 LVM/EDV 和 EDV）、“偏心扩张型”（EDV 增加，正常 LVM/EDV）、“同心非扩张型”（增加 LVM/EDV，正常 EDV）和“同心扩张型”（增加 LVM/EDV 和 EDV），并与正常 LVM 患者进行比较。基线时，12%的患者为偏心非扩张型，20%为偏心扩张型，29%为同心非扩张型，14%为同心扩张型，25%的患者为正常 LVM。与同心非扩张型 LVH 组相比，同心扩张型 LVH 患者的脉压/射血指数和射血分数明显较低；左心室中层缩短、左心房容积和等容松弛时间的左心室质量指数、每搏量、心输出量和 LVM 指数较高；节段性壁运动异常较多（均 P<0.05）。偏心扩张型和偏心非扩张型 LVH 患者之间也存在类似差异（均 P<0.05）。与正常 LVM 患者相比，偏心非扩张型患者的左心室每搏量、脉压/射血指数、康奈尔电压产物和 SBP 较高，心率较低，非裔美国人较少（均 P<0.05）。