Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan.
Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan.
Int J Cardiol. 2022 Nov 15;367:74-80. doi: 10.1016/j.ijcard.2022.08.050. Epub 2022 Sep 5.
It is unclear whether afterload mismatch occurs during the initial stage of essential hypertension (EHT). Additionally, critical left ventricular hypertrophy (LVH) between preserved and reduced systolic functions in hypertension is also unclear. Thus, we aimed to clarify these points.
Forty-five normal control subjects (NCS) and 140 EHT patients participated. EHT patients were subdivided into three groups: group I, without LVH (n = 37); group II, with LVH (n = 80); and group III, with LVH and LV heart failure (LVHF) (n = 23). Routine electrocardiographic and echocardiographic parameters, V5R/V6R ratio, relative wall thickness (RWT), LV mass (LVM) index, and peak systolic wall stress (PSWS) were measured.
In group I, LV systolic functions were preserved despite the increase of PSWS. In group II, LVH advanced, but LV systolic functions remained normal. A negative T-wave was observed in 69% of group II and 100% of group III. A significant correlation between RWT and LVM index was seen in NCS and groups I and II (r = 0.545, P < 0.0001) but not in group III. Afterload mismatch occurred in group III due to the decrease in V5R/V6R ratio, the increase of LV end-diastolic dimension, and the LV systolic dysfunctions, which are caused by exhaustion of preload reserve. The boundary of the LVM index between groups II and III was approximately 180 g/m.
Afterload mismatch did not occur in group I, but it was observed in group III due to the exhaustion of preload reserve.
在原发性高血压（EHT）的初始阶段是否存在后负荷不匹配尚不清楚。此外，高血压患者中收缩功能保留和降低之间的临界左心室肥厚（LVH）也不清楚。因此，我们旨在阐明这些问题。
共有 45 名正常对照组（NCS）和 140 名 EHT 患者参加。EHT 患者分为三组：I 组，无 LVH（n=37）；II 组，LVH（n=80）；III 组，LVH 伴 LV 心力衰竭（LVHF）（n=23）。测量常规心电图和超声心动图参数、V5R/V6R 比值、相对壁厚度（RWT）、LV 质量（LVM）指数和峰值收缩壁应力（PSWS）。
在 I 组中，尽管 PSWS 增加，但 LV 收缩功能仍保留。在 II 组中，LVH 进展，但 LV 收缩功能仍正常。II 组 69%和 III 组 100%观察到负 T 波。NCS 和 I 组和 II 组中 RWT 与 LVM 指数之间存在显著相关性（r=0.545，P<0.0001），但在 III 组中则不然。由于前负荷储备耗尽导致 V5R/V6R 比值降低、LV 舒张末期内径增加和 LV 收缩功能障碍，III 组发生了后负荷不匹配。LVM 指数在 II 组和 III 组之间的边界约为 180 g/m。
I 组未发生后负荷不匹配，但由于前负荷储备耗尽，III 组观察到后负荷不匹配。
