在老年男性高血压患者中，主动脉钙化与动脉僵硬度增加、左心室肥厚及舒张功能障碍相关。

Aortic calcification is associated with arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction in elderly male patients with hypertension.

作者信息

Cho In-Jeong, Chang Hyuk-Jae, Park Hyung-Bok, Heo Ran, Shin Sanghoon, Shim Chi Young, Hong Geu-Ru, Chung Namsik

机构信息

aDivision of Cardiology, Department of Internal Medicine bSeverance Biomedical Science Institute, Yonsei University College of Medicine, Seoul cDivision of Cardiology, Department of Internal Medicine, College of Medicine, Kwandong University, Gangneung dDivision of Cardiology, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea.

出版信息

J Hypertens. 2015 Aug;33(8):1633-41. doi: 10.1097/HJH.0000000000000607.

DOI:10.1097/HJH.0000000000000607

PMID:26002844

Abstract

BACKGROUND

Stiffening of large arteries can result in changes of cardiac structure and function by increasing afterload to the left ventricle. Calcification has been proposed as a mechanism underlying progression of arterial stiffening. The aim of the current study was to investigate the relationship between aortic calcification, arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction.

METHODS

One hundred and sixty-four hypertensive elderly (≥65 years old) male patients with normal left ventricular systolic function (left ventricular ejection fraction ≥55%) underwent transthoracic echocardiography, brachial-ankle pulse wave velocity (baPWV), and noncontrast computed tomography. Coronary artery calcium score and aorta calcium score (ACS) were measured on noncontrast computed tomography using the volume method. Left ventricular dimensions, mitral inflow velocities, and early mitral annular (E') velocity were measured using transthoracic echocardiography. The left ventricular mass index (LVMI) was calculated.

RESULTS

The logACS was associated with mean baPWV (r = 0.387, P = 0.001), LVMI (r = 0.241, P < 0.002), E' velocity (r = -0.293, P < 0.001), and E/E' (r = 0.194, P = 0.013), suggesting arterial stiffening, increased left ventricular mass, and diastolic dysfunction in patients with raised ACS. On multivariate analysis, the LVMI showed an independent positive association with the logACS, even after adjusting for various clinical variables and the coronary artery calcium score (P = 0.009). Similarly, E' velocity also demonstrated an independent negative association with the logACS on multivariate analysis (P = 0.003). The mean baPWV, LVMI, and E' velocity showed similar correlations with both thoracic and abdominal ACS, even when thoracic and abdominal calcium scores were calculated separately.

CONCLUSION

Heavy aortic calcification and resultant arterial stiffening might underlie left ventricular hypertrophy and diastolic dysfunction in elderly male patients with hypertension.

摘要

背景

大动脉僵硬度增加可通过增加左心室后负荷导致心脏结构和功能改变。钙化被认为是动脉僵硬度进展的潜在机制。本研究旨在探讨主动脉钙化、动脉僵硬度、左心室肥厚和舒张功能障碍之间的关系。

方法

164例左心室收缩功能正常（左心室射血分数≥55%）的老年（≥65岁）男性高血压患者接受了经胸超声心动图、臂踝脉搏波速度（baPWV）和非增强计算机断层扫描检查。使用容积法在非增强计算机断层扫描上测量冠状动脉钙化评分和主动脉钙化评分（ACS）。使用经胸超声心动图测量左心室尺寸、二尖瓣流入速度和二尖瓣环早期（E'）速度。计算左心室质量指数（LVMI）。

结果

logACS与平均baPWV（r = 0.387，P = 0.001）、LVMI（r = 0.241，P < 0.002）、E'速度（r = -0.293，P < 0.001）和E/E'（r = 0.194，P = 0.013）相关，提示ACS升高的患者存在动脉僵硬度增加、左心室质量增加和舒张功能障碍。多因素分析显示，即使在调整了各种临床变量和冠状动脉钙化评分后，LVMI与logACS仍呈独立正相关（P = 0.009）。同样，多因素分析中E'速度也与logACS呈独立负相关（P = 0.003）。即使分别计算胸部和腹部钙化评分，平均baPWV、LVMI和E'速度与胸部和腹部ACS的相关性相似。