Hypertension Research Center (CIRIAPA).
Department of Advanced Biomedical Sciences.
J Hypertens. 2018 Aug;36(8):1697-1704. doi: 10.1097/HJH.0000000000001717.
Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability.
We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients.
One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women.
An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P < 0.0001) was lower in patients with elevated LVM/EDV ratio. By a multilinear regression analysis, after adjusting for sex, age, heart rate, mean blood pressure and BMI, stroke volume was independently and negatively associated to LVM/EDV ratio (β = -0.55, P < 0.0001).
In native hypertensive patients, 3D-echo-derived LVM/EDV ratio identifies a higher prevalence of LV concentric geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.
通过心脏磁共振技术，已经发现左心室（LV）质量/舒张末期容积比（LVM/EDV）升高与高血压患者心肌纤维化和功能障碍的证据更高有关，该技术的可用性有限。
我们研究了三维（3D）超声心动图在根据 LVM/EDV 比识别 LV 向心性几何结构表型的能力，这可能可以在原发性高血压患者中检测到早期心肌损伤。
128 名原发性高血压患者接受了 2D 和 3D 超声心动图检查。根据 90 名健康血压正常个体的 3D-LVM/EDV 比的上 95%置信区间的截断值，将人群分为两组：男性 3D-LVM/EDV 比截断值为 1.22，女性为 1.23。
与 2D 衍生的相对壁厚度相比，增加的 3D-LVM/EDV 比确定了更高的 LV 向心性几何率（37%比 24%，P=0.03）。男性 LVM/EDV 比为 1.22 或更高，女性为 1.23 或更高的患者年龄更大，3D-LV 舒张末期和收缩末期容积更小，左室质量指数更高，但射血分数无差异。3D 心排量（P<0.0001）在 LVM/EDV 比值升高的患者中较低。通过多元线性回归分析，在校正性别、年龄、心率、平均血压和 BMI 后，心排量与 LVM/EDV 比呈独立负相关（β=-0.55，P<0.0001）。
在原发性高血压患者中，3D 超声心动图衍生的 LVM/EDV 比比 2D 相对壁厚度更能识别出更高的 LV 向心性几何结构。心排量与 LVM/EDV 比呈独立负相关，其降低代表 LV 向心性几何结构的高血压患者心肌功能障碍的早期标志物。
