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未经治疗的高血压患者肱踝脉搏波速度与左心室几何结构和舒张功能的相关性

Associations of Brachial-Ankle Pulse Wave Velocity With Left Ventricular Geometry and Diastolic Function in Untreated Hypertensive Patients.

作者信息

Kwak Soongu, Kim Hack-Lyoung, In Minjae, Lim Woo-Hyun, Seo Jae-Bin, Kim Sang-Hyun, Zo Joo-Hee, Kim Myung-A

机构信息

Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.

Seoul National University College of Medicine, Seoul, South Korea.

出版信息

Front Cardiovasc Med. 2021 May 10;8:647491. doi: 10.3389/fcvm.2021.647491. eCollection 2021.

Abstract

Although brachial-ankle pulse wave velocity (baPWV) is simple and convenient, its usefulness as an initial screening test for hypertensive patients is not well-known. This study aimed to investigate the association of baPWV with left ventricular (LV) geometry and diastolic function in treatment-naive hypertensive patients. A total of 202 untreated hypertensive patients (mean age, 62 years; males, 51.5%) without documented cardiovascular diseases were prospectively enrolled. Both baPWV and transthoracic echocardiography were performed on the same day before antihypertensive treatment. In multiple linear regression analysis after adjustment for potential confounders, baPWV had significant correlations with structural measurements of LV including relative wall thickness (β = 0.219, = 0.021) and LV mass index (β = 0.286, = 0.002), and four diastolic parameters including septal e' velocity (β = -0.199, = 0.018), E/e' (β = 0.373, < 0.001), left atrial volume index (β = 0.334, < 0.001), and maximal velocity of tricuspid regurgitation (β = 0.401, < 0.001). The baPWV was significantly increased in patients with LV hypertrophy, abnormal LV remodeling, or diastolic dysfunction, compared to those without ( = 0.008, = 0.035, and < 0.001, respectively). In the receiver operating characteristic curve analysis, the discriminant ability of baPWV in predicting LV hypertrophy and diastolic dysfunction had an area under the curve of 0.646 (95% confidence interval 0.544-0.703, = 0.004) and 0.734 (95% confidence interval 0.648-0.800, < 0.001), respectively. baPWV was associated with parameters of LV remodeling and diastolic function in untreated hypertensive patients. The baPWV could be a useful screening tool for the early detection of adverse cardiac features among untreated hypertensive patients.

摘要

虽然臂踝脉搏波速度(baPWV)测量方法简单便捷,但其作为高血压患者初始筛查试验的效用尚不为人所知。本研究旨在探讨初治高血压患者的baPWV与左心室(LV)几何形态及舒张功能之间的关联。前瞻性纳入了202例无心血管疾病记录的未治疗高血压患者(平均年龄62岁;男性占51.5%)。在进行降压治疗前,于同一天测量baPWV并进行经胸超声心动图检查。在对潜在混杂因素进行校正后的多元线性回归分析中,baPWV与LV的结构测量指标显著相关,包括相对室壁厚度(β = 0.219,P = 0.021)和LV质量指数(β = 0.286,P = 0.002),还与四个舒张参数显著相关,包括室间隔e'速度(β = -0.199,P = 0.018)、E/e'(β = 0.373,P < 0.001)、左心房容积指数(β = 0.334,P < 0.001)以及三尖瓣反流最大速度(β = 0.401,P < 0.001)。与无LV肥厚、LV重构异常或舒张功能障碍的患者相比,存在这些情况的患者baPWV显著升高(分别为P = 0.008、P = 0.035和P < 0.001)。在受试者工作特征曲线分析中,baPWV预测LV肥厚和舒张功能障碍的判别能力曲线下面积分别为0.646(95%置信区间0.544 - 0.703,P = 0.004)和0.734(95%置信区间0.648 - 0.800,P < 0.001)。baPWV与未治疗高血压患者的LV重构及舒张功能参数相关。baPWV可能是早期发现未治疗高血压患者不良心脏特征的有用筛查工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1fdc/8143267/0f3493031847/fcvm-08-647491-g0001.jpg

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