Khan Abdur Rahman, Sheikh Mujeeb, Kaw Dinkar, Cooper Christopher J, Khouri Samer J
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
Division of Nephrology, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
J Am Soc Hypertens. 2014 Apr;8(4):254-61. doi: 10.1016/j.jash.2014.01.008. Epub 2014 Jan 27.
The objective of this study is to evaluate the prevalence, geometric patterns, and factors associated with left ventricular remodeling in patients with renal artery stenosis (RAS). Demographic, clinical, and echocardiographic data were assessed in 77 patients with RAS prior to endovascular stenting. The left ventricular mass index (LVMI) and relative wall thickness were calculated using American Society of Echocardiography (ASE) recommendations. Patients were classified based on LVMI and relative wall thickness into four ventricular remodeling patterns: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Logistic regression was done to investigate the determinants of the different ventricular remodeling patterns. Mean LVMI and relative wall thickness were 118 ± 40 g/m(2) and 0.45 ± 0.1. Left ventricular hypertrophy was observed in 65%. CH was the most prevalent geometric pattern of remodeling (normal, 16.9%; CR, 18.2%; CH, 40%; EH, 24.6%). Thirty (39%) patients had an abnormal LV systolic function (ejection fraction <55%), with 14 (46%) of them having eccentric hypertrophy. Independent predictor of EH was glomerular filtration rate (odds ratio [OR], 0.943; confidence interval [CI], 0.899-0.989; P = .01). Systolic elevation of blood pressure (OR, 1.030; CI, 1.003-1.058; P = .03) was associated with CH, and elevated diastolic blood pressure was associated with CR (OR, 0.927; CI, 0.867-0.992; P = .02). Patients with RAS have a high prevalence of left ventricular remodeling and LVH. Even though CH was the most prevalent pattern of left ventricular remodeling, EH was commonplace and was associated with renal dysfunction and heart failure.
本研究的目的是评估肾动脉狭窄（RAS）患者左心室重构的患病率、几何模式及相关因素。在77例接受血管内支架置入术的RAS患者中评估了人口统计学、临床和超声心动图数据。根据美国超声心动图学会（ASE）的建议计算左心室质量指数（LVMI）和相对室壁厚度。根据LVMI和相对室壁厚度将患者分为四种心室重构模式：正常几何形态、向心性重构（CR）、向心性肥厚（CH）和离心性肥厚（EH）。采用逻辑回归分析来研究不同心室重构模式的决定因素。LVMI和相对室壁厚度的平均值分别为118±40g/m²和0.45±0.1。65%的患者观察到左心室肥厚。CH是最常见的重构几何模式（正常，16.9%；CR，18.2%；CH，40%；EH，24.6%）。30例（39%）患者左心室收缩功能异常（射血分数<55%），其中14例（46%）为离心性肥厚。EH的独立预测因素是肾小球滤过率（比值比[OR]，0.943；置信区间[CI]，0.899 - 0.989；P = 0.01）。收缩压升高（OR，1.030；CI，1.003 - 1.058；P = 0.03）与CH相关，舒张压升高与CR相关（OR，0.927；CI，0.867 - 0.992；P = 0.02）。RAS患者左心室重构和左心室肥厚的患病率较高。尽管CH是左心室重构最常见的模式，但EH也很常见，且与肾功能不全和心力衰竭相关。
