Gu Haotian, Sinha Manish D, Li Ye, Simpson John, Chowienczyk Phil J
Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, London, United Kingdom
Hypertension. 2015 Oct;66(4):823-9. doi: 10.1161/HYPERTENSIONAHA.115.05704.
Myocardial wall stress (MWS) is thought to be the mechanical stimulus to ventricular hypertrophy. The objective of this study was to examine whether MWS is elevated in children with chronic kidney disease (CKD) who are at high risk of developing adverse cardiovascular events related to left ventricular (LV) hypertrophy. MWS, a function of left ventricular pressure, myocardial wall volume, and cavity volume, was obtained using carotid tonometry to estimate ventricular pressure and 2-dimensional transthoracic echocardiographic wall-tracking to obtain LV cavity and wall volumes. Ninety-two children (50 boys) aged 11.2±3.2 (mean±SD) years, including healthy controls (n=16), and those with CKD disease divided into 3 groups according to estimated glomerular filtration rate (mL/min per 1.73 m2) >90 (CKD 1, n=26), 60 to 90(CKD 2, n=23), and <60 (CKD≥3, n=27) were studied. There was no significant difference in age, height, weight, central or peripheral blood pressure, LV mass, or mass index in the 4 study groups. By contrast, peak, mean, and end-systolic MWS were higher in children with CKD and increased across stages of CKD (peak MWS, 338.8±18.5 and 397.5±14.3 s/cm2 in controls and CKD≥3, respectively; P=0.01). Higher systolic MWS was explained by a form of LV dysfunction whereby dynamic values of the ratio of wall volume/cavity size during systole were lower in children with CKD than in those without (P=0.001). Children with CKD exhibit blood pressure–independent LV dysfunction which results in increased systolic MWS and which may predispose to LV hypertrophy in later life.
心肌壁应力（MWS）被认为是心室肥厚的机械刺激因素。本研究的目的是检验在有发生与左心室（LV）肥厚相关的不良心血管事件高风险的慢性肾脏病（CKD）儿童中，MWS是否升高。MWS是左心室压力、心肌壁容积和腔容积的函数，通过颈动脉压力测定法估计心室压力，并采用二维经胸超声心动图壁追踪法获取左心室腔和壁容积来得出MWS。研究了92名年龄为11.2±3.2（均值±标准差）岁的儿童（50名男孩），包括健康对照者（n = 16），以及根据估计肾小球滤过率（毫升/分钟每1.73平方米）分为三组的CKD患儿：>90（CKD 1，n = 26）、60至90（CKD 2，n = 23）和<60（CKD≥3，n = 27）。四个研究组在年龄、身高、体重、中心或外周血压、左心室质量或质量指数方面无显著差异。相比之下，CKD患儿的峰值、平均和收缩末期MWS更高，且在CKD各阶段均升高（对照组和CKD≥3组的峰值MWS分别为338.8±18.5和397.5±14.3 s/cm²；P = 0.01）。收缩期MWS较高是由一种左心室功能障碍形式所致，即CKD患儿收缩期壁容积/腔大小比值的动态值低于无CKD者（P = 0.001）。CKD患儿表现出与血压无关的左心室功能障碍，这导致收缩期MWS升高，可能使他们在晚年易发生左心室肥厚。
