Osovska Natalia Y, Datsyuk Oleksandr I, Shaprynskyi Yevhen V, Shamrai Volodymyr A, Hruhorenko Andrii M, Chechuha Sergii B, Bevz Hennadii V, Karyi Yaroslav V, Tserkovniuk Ruslan G, Sheremeta Bogdan V, Mazur Yulia V
National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Wiad Lek. 2017;70(6 pt 1):1051-1056.
Introduction: Heart remodeling is a complex multifactor process determining the prognosis of the patient with any cardio-vascular pathology. There are convincing observations and conclusions in literature about the formation of concentric remodeling of LV prior to the appearance of any changes in AP [4, 5]. But until now there is no common point of view as to the factors involved in remodeling both the myocardium and the vessels, especially in the absence of the major known causative factor - arterial hypertension. From this perspective the study of relationship between cardiac and vascular remodeling as well as the factors involved in their development, especially in young individuals, is urgent. The aim of this work was a comparative study of characteristic features of intracardiac hemodynamics, daily profile of arterial pressure, daily ECG monitoring data and vegetative regulation in young apparently healthy individuals (18-44 years) with normal heart geometry and those with concentric remodeling of left ventricle.
Materials and Methods: Apparently healthy persons aged 18 to 42 years, mean age 25.3±0.6 years, were included in the study. There were 56 males (73.7%) and 20 females (26.36%). All participants of the study were divided into two equal groups consisting of 38 persons according to relative wall thickness (RWT) value of the left ventricle: the patients with RWT > 0.42 (concentric remodeling of left ventricle) and those with RWT ≤ 0.42 (normal geometry of left ventricle).
Results and Conclusion: The analysis of obtained findings revealed comparatively larger sizes of left heart cavities, comparatively higher rate of AP morning rise and daily variability of predominantly systolic arterial pressure, decreased activity of parasympathetic nervous system, greater number of supraventricular premature beats mainly at night time as well as the signs of connective tissue dysplasia in the patients with concentric remodeling of left ventricle. More than half of young persons with concentric remodeling of left ventricle showed the signs of connective tissue heart dysplasia, namely prolapse of mitral valve and abnormal left ventricular chords. Those specific characteristics of heart structure, daily profile of arterial pressure and variability of cardiac rhythm can be considered the signs associated with concentric remodeling of left ventricle.
引言：心脏重塑是一个复杂的多因素过程，决定着任何心血管疾病患者的预后。关于左心室在动脉血压出现任何变化之前发生向心性重塑的形成，文献中有令人信服的观察结果和结论[4,5]。但迄今为止，对于参与心肌和血管重塑的因素，尤其是在没有主要已知致病因素——动脉高血压的情况下，尚无统一观点。从这个角度来看，研究心脏和血管重塑之间的关系以及参与其发展的因素，尤其是在年轻人中，是紧迫的。这项工作的目的是对心脏几何结构正常的年轻健康个体（18 - 44岁）和左心室向心性重塑的个体进行心内血流动力学特征、动脉血压日变化曲线、每日心电图监测数据和自主神经调节的比较研究。
材料与方法：年龄在18至42岁之间、平均年龄为25.3±0.6岁的健康个体纳入研究。其中男性56例（73.7%），女性20例（26.36%）。根据左心室相对壁厚度（RWT）值，将所有研究参与者分为两组，每组38人：RWT > 0.42的患者（左心室向心性重塑）和RWT≤0.42的患者（左心室几何结构正常）。
结果与结论：对所得结果的分析显示，左心室向心性重塑患者的左心腔尺寸相对较大、动脉血压早晨升高幅度相对较高且主要是收缩期动脉血压的日变化较大、副交感神经系统活性降低、主要在夜间出现的室上性早搏数量较多以及结缔组织发育异常的迹象。超过一半的左心室向心性重塑的年轻人表现出结缔组织心脏发育异常的迹象，即二尖瓣脱垂和左心室异常腱索。心脏结构的这些特定特征、动脉血压日变化曲线和心律变异性可被视为与左心室向心性重塑相关的体征。
