高血压患者主动脉瓣结节宽度与亚临床左心室功能障碍的关系。
Relation between aortic knob width and subclinical left ventricular dysfunction in hypertensive patients.
机构信息
a Department of Cardiology , İstanbul Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery Training and Research Hospital , İstanbul , Turkey.
b Department of Cardiology , Osmaniye State Hospital , Osmaniye , Turkey.
出版信息
Clin Exp Hypertens. 2018;40(6):589-594. doi: 10.1080/10641963.2017.1411496. Epub 2018 Jan 29.
BACKGROUND
The assessment of left ventricular (LV) structure and function is important in the evaluation of hypertensive heart disease, as it provides information on the cardiovascular morbidity and mortality. Aortic knob width (AKW) is a measurement of radiographic structure formed by the foreshortened aortic arch and a portion of the descending aorta. The main aim of this study was to investigate the relation between AKW on the routine chest radiography and subclinical LV dysfunction in hypertensive patients.
PATIENTS AND METHODS
A total of 144 patients with hypertension admitted to the cardiology outpatients clinic were enrolled consecutively. The patients were divided into two groups according to tissue Doppler-derived myocardial performance index (MPI): subclinical LV dysfunction group (abnormal MPI ≥ 0.5, n = 85) and absence of subclinical LV dysfunction group (normal MPI< 0.5, n = 59).
RESULTS
Patients with subclinical LV dysfunction were older (60 ± 8 vs. 54 ± 8, p = 0.001). Left ventricular mass index (LVMI) (96 ± 27 vs. 74 ± 24, p < 0.001) and prevalence of LV hypertrophy (28 vs. 8%, p = 0.011) were significantly different between two groups. Patients with subclinical LV dysfunction had higher AKW (42 ± 6 vs. 34 ± 5, p < 0.001) compared with patients without subclinical LV dysfunction. There was a significant correlation between MPI and AKW (r = 0.7, p < 0.001). Multiple logistic regression analysis showed that AKW (β = 0.617, p = 0.001) and posterior wall thickness (PWth) (β = 1.189, p = 0.021) were independently associated with subclinical LV dysfunction. Analysis using the Receiver Operating Characteristic (ROC) curve has demonstrated that aortic knob of 37 mm constitutes the cutoff value for the presence of subclinical LV dysfunction with 85.9% sensitivity and 86.4% specificity (The Area under the Curve ± Standard Error (AUC±SE) = 0.916 ± 0.024, p < 0.001).
CONCLUSION
AKW may provide important predictive information on subclinical LV dysfunction in patients with hypertension.
背景
评估左心室（LV）结构和功能对于高血压性心脏病的评估很重要，因为它提供了心血管发病率和死亡率的信息。主动脉结宽度（AKW）是由缩短的主动脉弓和一部分降主动脉形成的放射学结构的测量值。本研究的主要目的是探讨常规胸部 X 线摄影中的 AKW 与高血压患者亚临床 LV 功能障碍之间的关系。
患者和方法
连续纳入 144 例心内科门诊高血压患者。根据组织多普勒衍生的心肌做功指数（MPI）将患者分为两组：亚临床 LV 功能障碍组（异常 MPI≥0.5，n=85）和无亚临床 LV 功能障碍组（正常 MPI<0.5，n=59）。
结果
亚临床 LV 功能障碍组患者年龄较大（60±8 岁 vs. 54±8 岁，p=0.001）。两组间左心室质量指数（LVMI）（96±27 与 74±24，p<0.001）和 LV 肥厚发生率（28%与 8%，p=0.011）差异有统计学意义。与无亚临床 LV 功能障碍的患者相比，亚临床 LV 功能障碍患者的 AKW 更高（42±6 与 34±5，p<0.001）。MPI 与 AKW 呈显著相关（r=0.7，p<0.001）。多因素 logistic 回归分析显示，AKW（β=0.617，p=0.001）和后壁厚度（PWth）（β=1.189，p=0.021）与亚临床 LV 功能障碍独立相关。ROC 曲线分析显示，主动脉结宽度为 37mm 时亚临床 LV 功能障碍的存在具有 85.9%的敏感性和 86.4%的特异性（曲线下面积±标准误（AUC±SE）=0.916±0.024，p<0.001）。
结论
AKW 可能为高血压患者亚临床 LV 功能障碍提供重要的预测信息。
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