Caruana M, Al-Khawaja I, Lahiri A, Lewis J, Raftery E B
Department of Cardiology, Northwick Park Hospital, Middlesex.
Br Heart J. 1988 Feb;59(2):218-26. doi: 10.1136/hrt.59.2.218.
Three measurements of diastolic filling were compared in 29 patients with essential hypertension and 27 age matched normotensive controls. Systolic function was normal in all but one of the patients. The mean (1SD) first one third filling fraction (a measurement of early diastolic filling) was significantly lower in the hypertensive groups (0.27 (0.24] than in the control group (0.45 (0.16)). The hypertensive group was subdivided into those with electrocardiographic abnormalities and those without. In the subgroup with a normal electrocardiogram the mean (1SD) first one third filling fraction measurement (0.28 (0.16)) was significantly lower than in the control group. In the subgroup with an abnormal electrocardiogram, the first one third filling fraction was even lower (0.24 (0.9)). In addition, the time to peak filling rate (213 (56) ms) was significantly longer in the subgroup with the abnormal electrocardiogram than in the control group (164 (45) ms). However, the interobserver reproducibility of the time to peak filling measurement was poor. The peak filling rate was low in the subgroup with an abnormal electrocardiogram, but not significantly different from the normal controls. The discriminatory value of the three diastolic measurements did not improve with exercise. These results showed an early diastolic filling abnormality in essential hypertension that did not appear to be caused by disease of the large coronary vessels as it was present in patients with normal wall motion and a normal exercise electrocardiogram. The occurrence of diastolic abnormalities when systolic function is still normal may mark an early stage in the development of hypertensive heart failure, at a time when the process is still potentially reversible.
对29例原发性高血压患者和27例年龄匹配的血压正常对照者的舒张期充盈进行了三项测量比较。除1例患者外，所有患者的收缩功能均正常。高血压组的平均（标准差）前三分之一充盈分数（早期舒张期充盈的一种测量指标）（0.27（0.24））显著低于对照组（0.45（0.16））。高血压组又被分为有心电图异常和无心电图异常的两组。在心电图正常的亚组中，平均（标准差）前三分之一充盈分数测量值（0.28（0.16））显著低于对照组。在心电图异常的亚组中，前三分之一充盈分数更低（0.24（0.09））。此外，心电图异常亚组的达到峰值充盈率的时间（213（56）毫秒）显著长于对照组（164（45）毫秒）。然而，达到峰值充盈时间测量的观察者间重复性较差。心电图异常亚组的峰值充盈率较低，但与正常对照组无显著差异。三项舒张期测量指标的鉴别价值在运动后并未改善。这些结果表明，原发性高血压存在早期舒张期充盈异常，这似乎并非由大冠状动脉疾病引起，因为在室壁运动正常且运动心电图正常的患者中也存在这种异常。当收缩功能仍正常时出现舒张期异常可能标志着高血压性心力衰竭发展的早期阶段，此时该过程仍可能是可逆的。
