Centre for Cardiovascular Imaging, University College London, United Kingdom (J.A.H., V.M., A.M.T.).
Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Austria (J.A.H.).
Circ Cardiovasc Imaging. 2019 Nov;12(11):e009172. doi: 10.1161/CIRCIMAGING.119.009172. Epub 2019 Nov 11.
Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular disease, including heart failure. Although linked to obesity and hypertension, its pathogenesis is multifactorial. Blunted postprandial sympathetic regulation of gut blood flow has been observed in overweight animals and suggested as a promotor of hypertension and LVH. We hypothesized that blunted postprandial superior mesenteric blood flow responses would be more common in overweight humans and associated with increased blood pressure and LVH.
Left ventricular dimensions and hemodynamic responses to a standardized high-calorie liquid meal were measured in healthy adolescents (n=82; 39 overweight/obese) by magnetic resonance imaging. Covariates such as body mass index, blood pressure, Tanner score, and an index of insulin resistance were included in multiple regression models to examine the independent associations of mesenteric flow response with blood pressure status and LVH.
Food ingestion increased cardiac output (Δmean, 0.45 [SD, 0.62] L·min; =3.8×10) and superior mesenteric artery flow (Δmean, 0.76 [SD, 0.35] L·min; =4.2×10). A blunted mesenteric flow response was associated with increased left ventricular mass (B=-12.7 g·m per L·min·m; =6×10) and concentric LVH (log likelihood, -9.9; =0.001), independently of known determinants of LVH, including body mass index. It was also associated with elevated systolic blood pressure (B=-18.0 mm Hg per L·min·m; =0.001), but this link did not explain the association with left ventricular mass.
Postprandial mesenteric vascular dysfunction is associated with LVH and hypertension, independently of common risk factors for those conditions. These findings highlight a new, independent marker of cardiovascular risk in the young.
左心室肥厚（LVH）是心血管疾病的主要危险因素，包括心力衰竭。尽管它与肥胖和高血压有关，但它的发病机制是多因素的。超重动物的餐后交感神经对肠道血流的调节减弱已被观察到，并被认为是高血压和 LVH 的促进因素。我们假设，超重人群餐后肠系膜血流反应减弱更为常见，与血压升高和 LVH 相关。
通过磁共振成像测量健康青少年（n=82；39 名超重/肥胖）左心室尺寸和对标准化高热量液体餐的血液动力学反应。将体重指数、血压、Tanner 评分和胰岛素抵抗指数等协变量纳入多元回归模型，以检查肠系膜血流反应与血压状态和 LVH 的独立关联。
进食增加心输出量（Δ均值，0.45[SD，0.62]L·min；=3.8×10）和肠系膜上动脉血流（Δ均值，0.76[SD，0.35]L·min；=4.2×10）。肠系膜血流反应减弱与左心室质量增加（B=-12.7 g·m per L·min·m；=6×10）和向心性 LVH（对数似然比，-9.9；=0.001）有关，与包括体重指数在内的已知 LVH 决定因素独立相关。它还与收缩压升高（B=-18.0 mm Hg per L·min·m；=0.001）相关，但这种关联并不能解释与左心室质量的关联。
餐后肠系膜血管功能障碍与 LVH 和高血压相关，与这些疾病的常见危险因素无关。这些发现突出了年轻人群中心血管风险的一个新的、独立的标志物。
