Verdecchia Paolo, Angeli Fabio, Mazzotta Giovanni, Bartolini Claudia, Garofoli Marta, Aita Adolfo, Poltronieri Cristina, Pinzagli Maria Gabriella, Valecchi Francesca, Martone Stefania, Ramundo Elisa, Turturiello Dario, Reboldi Gianpaolo
Department of Medicine, Hospital of Assisi, Italy
Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy.
J Am Heart Assoc. 2017 May 24;6(6):e005948. doi: 10.1161/JAHA.117.005948.
The different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear.
We studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24-hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow-up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient-years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log-rank test: <0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24-hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model.
In initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.
左心室不同的几何形态可能与心室扩张并存，也可能不并存。这种组合对预后的影响尚不清楚。
我们研究了一组2635例初始未治疗的高血压患者，平均年龄50岁。入组时，24小时动态血压在正常几何形态、同心性左心室（LV）重构、偏心性非扩张性LV肥厚（LVH）、偏心性扩张性LVH、同心性非扩张性LVH和同心性扩张性LVH模式中逐渐升高。在平均9.7年的随访期间，360例患者发生了首次重大心血管事件，发生率（每100患者年）为1.41。LV几何形态正常组的事件发生率为0.93，LV同心性重构组为1.10，非扩张性偏心性LVH组为1.40，偏心性扩张性LVH组为2.10，非扩张性同心性LVH组为2.34，扩张性同心性LVH组为4.67（对数秩检验：<0.001）。在Cox模型中，在对几个独立协变量（年龄、性别、糖尿病、当前吸烟、总胆固醇、估计肾小球滤过率和平均24小时收缩压）进行调整后，同心性扩张性LVH与心血管事件风险增加98%相关（=0.0037）。然而，当LV质量纳入模型时，LV几何形态模式失去统计学意义。
在初始未治疗的高血压患者中，LV扩张给偏心性和同心性LVH模式增加了不良预后负担。这种现象可通过与LV腔扩张相关的更大LV质量来解释。
