高血压患者右心室和右心房力学与功能能力之间存在关联吗？

Is there a relationship between right-ventricular and right atrial mechanics and functional capacity in hypertensive patients?

作者信息

Tadic Marijana, Cuspidi Cesare, Suzic-Lazic Jelena, Andric Anita, Stojcevski Biljana, Ivanovic Branislava, Hot Senada, Scepanovic Radisav, Celic Vera

机构信息

aUniversity Clinical Hospital Center 'Dr Dragisa Misovic', Heroja Milana Tepica 1, Belgrade, Serbia bUniversity of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy cClinical Centre of Serbia, Clinic of Cardiology, Koste Todorovic 8 dFaculty of Medicine, Doktora Subotica 6, Belgrade, Serbia.

出版信息

J Hypertens. 2014 Apr;32(4):929-37. doi: 10.1097/HJH.0000000000000102.

DOI:10.1097/HJH.0000000000000102

PMID:24434853

Abstract

BACKGROUND

We sought to assess right-ventricular and right atrial deformation in patients with arterial hypertension by two-dimensional speckle tracking imaging and three-dimensional echocardiography (3DE), and define the relationship between right-ventricular mechanics and exercise capacity in the study population.

METHODS

This cross-sectional study included recently diagnosed untreated hypertensive patients, well controlled hypertensive patients, treated patients with unsatisfactory controlled blood pressure and control individuals adjusted by sex and age. All the patients underwent complete two-dimensional echocardiography and 3DE examination, as well as cardiopulmonary exercise testing.

RESULTS

Right-ventricular strain, and systolic and early diastolic strain rates were significantly decreased in the untreated and the uncontrolled hypertensive patients in comparison with the controls and the well controlled participants. Similar results were obtained for right atrial strain and strain rates. 3DE right-ventricular volumes were increased, whereas 3DE right-ventricular ejection fraction was decreased in the uncontrolled hypertensive patients in comparison with the controls and the well treated patients. Differences in 3DE right-ventricular volumes disappeared after adjustment for body surface area. Considering the whole study population, global right-ventricular strain (β = 0.29, P = 0.018) and 3D right-ventricular stroke volume (β = 0.22, P = 0.041) were independently associated with peak oxygen uptake (VO(2max)) which was significantly decreased in the untreated and the uncontrolled hypertensive patients in comparison with the remaining two groups.

CONCLUSION

Our study showed that right-ventricular and right atrial mechanics, as well as exercise capacity, are significantly deteriorated in the hypertensive patients who are untreated or ineffectively treated. Global right-ventricular strain and 3DE right-ventricular stroke volume are independently associated with functional capacity in the whole study population.

摘要

背景

我们试图通过二维斑点追踪成像和三维超声心动图（3DE）评估动脉高血压患者的右心室和右心房变形，并确定研究人群中右心室力学与运动能力之间的关系。

方法

这项横断面研究纳入了近期诊断出的未经治疗的高血压患者、血压控制良好的高血压患者、血压控制不佳的治疗患者以及按性别和年龄匹配的对照个体。所有患者均接受了完整的二维超声心动图和3DE检查，以及心肺运动测试。

结果

与对照组和血压控制良好的参与者相比，未经治疗和血压控制不佳的高血压患者的右心室应变、收缩期和舒张早期应变率均显著降低。右心房应变和应变率也得到了类似的结果。与对照组和治疗良好的患者相比，血压控制不佳的高血压患者的3DE右心室容积增加，而3DE右心室射血分数降低。调整体表面积后，3DE右心室容积的差异消失。在整个研究人群中，整体右心室应变（β = 0.29，P = 0.018）和3D右心室每搏输出量（β = 0.22，P = 0.041）与峰值摄氧量（VO₂max）独立相关，与其余两组相比，未经治疗和血压控制不佳的高血压患者的峰值摄氧量显著降低。