de Simone G, Di Lorenzo L, Costantino G, Moccia D, Buonissimo S, de Divitiis O
Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, University of Naples, Italy.
Hypertension. 1988 May;11(5):457-63. doi: 10.1161/01.hyp.11.5.457.
Forty-three subjects with uncomplicated primary hypertension and without echocardiographic left ventricular hypertrophy and 54 normotensive volunteers were studied by two-dimensional targeted M-mode echocardiography to evaluate systolic function and contractility before the development of compensatory hypertrophy. The ratio of peak systolic pressure to end-systolic dimension was used to assess left ventricular performance and was divided for either posterior wall thickness or cross-sectional area to generate hypertrophy-independent indices of inotropic state. Fractional shortening was normal in the hypertensive group, despite the increase in end-systolic stress. Systolic pressure/dimension ratio was higher in hypertensive subjects (p less than 0.001), as were hypertrophy-independent indices of inotropic state (p less than 0.005), which were inversely correlated to left ventricular mass (p less than 0.001). Values in 11 hypertensive subjects were above the upper confidence limit of the normal shortening/stress relation, which provides a load-independent measure of inotropic state. They showed high hypertrophy-independent indices of inotropic state (p less than 0.01), while the other hypertensive subjects did not. High fractional shortening, wall stress, and systolic pressure (p less than 0.01) were found in the subgroup with supernormal performance, while left ventricular mass was not different from that of other subgroups, depicting inadequate left ventricular hypertrophy. The duration of hypertension was the same in the subgroups. Supernormal inotropic state could be considered one form of primary adaptation to high wall stress that serves to maintain systolic ventricular performance.
对43例无并发症的原发性高血压患者（无超声心动图显示的左心室肥厚）和54名血压正常的志愿者进行了二维靶向M型超声心动图研究，以评估在代偿性肥厚发生之前的收缩功能和收缩性。用收缩压峰值与收缩末期内径的比值来评估左心室功能，并将其除以后壁厚度或横截面积，以生成与肥厚无关的心肌收缩状态指标。尽管收缩末期应力增加，但高血压组的缩短分数仍正常。高血压患者的收缩压/内径比值较高（p<0.001），与肥厚无关的心肌收缩状态指标也较高（p<0.005），这些指标与左心室质量呈负相关（p<0.001）。11名高血压患者的值高于正常缩短/应力关系的上置信限，该关系提供了一种与负荷无关的心肌收缩状态测量方法。他们显示出较高的与肥厚无关的心肌收缩状态指标（p<0.01），而其他高血压患者则没有。在表现超常的亚组中发现了高缩短分数、壁应力和收缩压（p<0.01），而左心室质量与其他亚组无差异，表明左心室肥厚不足。各亚组的高血压病程相同。超常的心肌收缩状态可被认为是对高壁应力的一种主要适应形式，有助于维持心室收缩功能。
