Sun Qiaobing, Pan Yu, Zhao Yixiao, Liu Yan, Jiang Yinong
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Geriatric Cerebrovasology, Baoji Central Hospital, Baoji, China.
Front Cardiovasc Med. 2022 Feb 24;9:814756. doi: 10.3389/fcvm.2022.814756. eCollection 2022.
Hypertension (HT) induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. In this study, we investigated the association between LA-LV-arterial coupling and nighttime systolic blood pressure (BP) as well as BP circadian rhythm in essential hypertension.
We enrolled 290 HT patients. All subjects were evaluated by 2- dimensional speckle tracking echocardiography (2DSTE), ambulatory 24 h BP monitoring (ABPM), and brachial-ankle pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers ( = 111), patients with a >10% reduction in BP at nighttime; non-dippers ( = 179), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LA), LA conduit strain (LA), and LA booster pump strain (LA). LA stiffness index (LASI) defined as the ratio of E/e' to LA, and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV-arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes.
Left atrial stiffness index was significantly higher in non-dippers [0.29 (0.21, 0.41)] than in dippers [0.26 (0.21, 0.33)] ( < 0.05). PWV/GLS was significantly higher in non-dippers [-80.9 (-69.3, -101.5)] than in dippers [-74.2 (-60.2, -90.6)] ( < 0.05). LA, LA, LA,and LV GLS were significantly lower in non-dippers than in dippers ( < 0.05). Multivariate linear regression analysis revealed that nighttime systolic BP was independently correlated with LASI and PWV/GLS, even adjusted for multiple clinical risk factors, LVMI, and LVEF.
The dipping pattern of BP was related to the abnormalities of myocardial mechanics and LA-LV-arterial coupling. However, absolute nocturnal systolic BP value maybe more important than BP circadian profile in the progression of abnormal LA-LV-arterial coupling.
高血压（HT）可导致左心房（LA）和左心室（LV）功能障碍以及动脉僵硬度增加。在本研究中，我们调查了原发性高血压患者中左心房-左心室-动脉耦联与夜间收缩压（BP）以及血压昼夜节律之间的关系。
我们纳入了290例高血压患者。所有受试者均通过二维斑点追踪超声心动图（2DSTE）、动态24小时血压监测（ABPM）和臂踝脉搏波速度（PWV）进行评估。根据血压模式，将这些患者分为两组，包括杓型血压者（n = 111），即夜间血压下降>10%的患者；非杓型血压者（n = 179），即夜间血压下降<10%的患者。研究基于2D-STE的左心房和左心室应变，并测量以下参数，左心室整体纵向应变（GLS）、左心房储存应变（LAres）、左心房管道应变（LAcon）和左心房增强泵应变（LAbp）。计算定义为E/e'与左心房比值的左心房僵硬度指数（LASI）以及PWV与GLS比值（PWV/GLS）以反映左心房-左心室-动脉耦联。此外，我们还探讨了LASI（或PWV/GLS）与动态血压指标之间的相关性。
非杓型血压者的左心房僵硬度指数[0.29（0.21，0.41）]显著高于杓型血压者[0.26（0.21，0.33）]（P<0.05）。非杓型血压者的PWV/GLS[-80.9（-69.3，-101.5）]显著高于杓型血压者[-74.2（-60.2，-90.6）]（P<0.05）。非杓型血压者的LAres、LAcon、LAbp和左心室GLS显著低于杓型血压者（P<0.05）。多因素线性回归分析显示，即使在调整了多个临床危险因素、左心室质量指数（LVMI）和左心室射血分数（LVEF）后，夜间收缩压仍与LASI和PWV/GLS独立相关。
血压的杓型模式与心肌力学和左心房-左心室-动脉耦联异常有关。然而，在左心房-左心室-动脉耦联异常进展过程中，夜间收缩压绝对值可能比血压昼夜节律更重要。
