升主动脉扩张时局部主动脉弓应变功能受损。

Local transversal aortic strain is impaired in ascending aorta dilatation.

机构信息

Internal Medicine and Hypertension Division, Department of Medical Sciences, AOU Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy.

出版信息

J Hypertens. 2021 Jul 1;39(7):1402-1411. doi: 10.1097/HJH.0000000000002757.

DOI:10.1097/HJH.0000000000002757

PMID:33399306

Abstract

BACKGROUND

Ascending aorta dilatation is found in 13% of hypertensive patients. Little is known about elastic properties of ascending aorta in such patients. Echo-based transverse aortic strain analysis can describe mechanical properties of ascending aorta but has never been applied to patients with ascending aorta dilatation.

AIM

To assess mechanical properties of ascending aorta by transverse aortic strain analysis (as β2-stiffness index) in hypertensive patients with ascending aorta dilatation and association between mechanical properties of ascending aorta and cardiovascular damage.

METHODS

A total of 100 hypertensive outpatients underwent transthoracic echocardiography and assessment of pulse wave velocity (PWV). Strain analysis of ascending aorta was performed with echocardiographic speckle-tracking software. Patients were divided in three groups based on ascending aorta diameter: less than 40, 40-45, and at least 45 mm.

RESULTS

Beta-SI increased exponentially with ascending aorta dimensions (P < 0.001). Patients with ascending aorta dilatation had Beta-SI significantly higher than those with normal ascending aorta diameter. A greater proportion of patient with impaired (i.e., elevated) Beta-SI was present in groups with larger ascending aorta (18.2 vs. 48.4 vs. 80%, respectively, P < 0.05). On multivariate logistic regression only impaired Beta-SI predicted ascending aorta dilatation (P < 0.001). Beta-SI was related to cardiovascular damage in terms of left ventricular (LV) mass (LV mass indexed to BSA, P = 0.030) and PWV (P = 0.028). Patients with high Beta-SI had greater LV mass indexed to BSA (117 ± 47 vs. 94 ± 24 g/m2; P = 0.010) and PWV (10.20 ± 2.99 vs. 8.63 ± 1.88 m/s; P = 0.013).

CONCLUSION

Ascending aorta dilatation is associated with increased local aortic stiffness in hypertensive patients. Strain analysis adds functional information to the mere morphological evaluation of aortic diameter and could be a useful tool to better define cardiovascular risk in this population.

摘要

背景

升主动脉扩张在 13%的高血压患者中被发现。对于此类患者升主动脉的弹性特性知之甚少。基于回声的横主动脉应变分析可以描述升主动脉的机械性能，但从未应用于升主动脉扩张的患者。

目的

通过横主动脉应变分析（β2-僵硬度指数）评估高血压伴升主动脉扩张患者升主动脉的机械特性以及升主动脉机械特性与心血管损害之间的关系。

方法

共 100 名高血压门诊患者接受了经胸超声心动图和脉搏波速度（PWV）评估。使用超声心动图斑点追踪软件对升主动脉进行应变分析。根据升主动脉直径将患者分为三组：小于 40、40-45 和至少 45mm。

结果

β-SI 与升主动脉尺寸呈指数增长（P<0.001）。升主动脉扩张患者的β-SI 明显高于升主动脉直径正常的患者。升主动脉较大的患者中，β-SI 受损（即升高）的比例更高（分别为 18.2%、48.4%和 80%，P<0.05）。多变量逻辑回归仅显示受损的β-SI 可预测升主动脉扩张（P<0.001）。β-SI 与心血管损害有关，表现在左心室（LV）质量（LV 质量与 BSA 指数化，P=0.030）和 PWV（P=0.028）。β-SI 较高的患者左心室质量指数化更高（117±47 与 94±24g/m2；P=0.010），PWV 更高（10.20±2.99 与 8.63±1.88m/s；P=0.013）。