Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Am J Hypertens. 2021 Dec 1;34(12):1300-1310. doi: 10.1093/ajh/hpab128.
Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear.
Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension.
Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (P < 0.0001) and eccentric (P < 0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial, or 24-hour blood pressures (BP), but neither increases in SVR or Zc nor decreases in TAC. LV RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall shortening and s') (P < 0.05 to <0.005) and decreases in LV systolic function were noted in concentric (P < 0.05), but not eccentric LVH.
In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH.
在以容量为主的原发性高血压中，左心室（LV）向心性重构（超过肥厚）是否代表压力而非容量超负荷的影响尚不清楚。
在一个具有以容量为主的原发性高血压的非洲裔人群中（n = 709），我们使用中心动脉压和主动脉速度及流出道直径（超声心动图）测量，确定与向心性 LVH 或重构相关的因素。
LV 质量指数（LVMI）和相对室壁厚度（RWT）与舒张末期容积（EDV）、每搏量（SV）和峰值主动脉流量（Q）呈正相关且独立相关（P < 0.05 至 <0.0001）。然而，LVMI 和 RWT 均与全身血管阻力（SVR）、主动脉特征阻抗（Zc）不呈正相关且不独立相关，或与总动脉顺应性（TAC）呈负相关。因此，向心性（P < 0.0001）和离心性（P < 0.0001）LVH 均与 EDV、SV 相似增加以及办公室肱动脉、中心动脉或 24 小时血压（BP）相似增加相关，但均与 SVR 或 Zc 增加或 TAC 减少无关。然而，LV 室壁 RWT 而非 LVMI 与心肌收缩功能（中层缩短和 s'）独立且呈负相关（P < 0.05 至 <0.005），且在向心性 LVH 中观察到 LV 收缩功能下降（P < 0.05），但在离心性 LVH 中未见。
在以容量为主的原发性高血压中，LV 向心性重构与全身性血流增加和增强的 BP 导致的容量依赖性增加有关，与离心性 LVH 一样。然而，向心性重构反映了 LVH 之外的收缩功能下降。
