Jacquemyn Xander, Van den Eynde Jef, Zhan Junzhen, Doshi Ashish N, Long Rita, Danford David A, Barnes Benjamin T, Kutty Shelby
Department of Pediatrics, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Am J Hypertens. 2023 Feb 24;36(3):159-167. doi: 10.1093/ajh/hpac134.
Myocardial work (MW) is an index of LV function based on pressure-strain loops and brachial cuff pressure measurement. MW has been proposed as more sensitive than conventional functional parameters, as it accounts for afterload and myocardial deformation. However, many studies have been limited to assessment of global MW indices, neglecting regional differences in cardiac associated with hypertension and consequent cardiac remodeling. We aimed to quantify regional MW in pediatric hypertension and compare the findings in renal or renovascular hypertension (RHTN) with essential hypertension (EHTN).
We retrospectively assessed conventional markers of LV function, and both global and regional MW indices in 78 patients (49 males, 15.4 ± 2.94 years) with EHTN and RHTN.
Peak systolic strain (PSS) in the basal septal segment was significantly impaired in patients with RHTN compared to EHTN (-13.00% [-15.50%; -13.00%] vs. -15.00% [-17.50%; -13.50%], P = 0.034). Similarly, basal septal MW indices were significantly elevated in patients with EHTN compared to RHTN, including MW efficiency (MWE) (95.0% [93.0%; 98.0%] vs. 94.0% [89.0%; 95.0%], P = 0.004) and constructive work (CW) (1700 mm Hg% (409 mm Hg%) vs. 1520 mm Hg% (336 mm Hg%), P = 0.037). Wasted work (WW) was significantly elevated in the RHTN group (79.0 mm Hg% [28.5 mm Hg%; 104 mm Hg%] vs. 105 mm Hg% [62.0 mm Hg%; 164 mm Hg%], P = 0.010).
Significant differences in basal septal PSS and MW indices were observed between EHTN and RHTN. These findings highlight the usefulness of regional MW indices in assessing disease and may help differentiate between etiologies of pediatric hypertension.
心肌做功（MW）是基于压力-应变环和肱动脉袖带压力测量的左心室功能指标。MW被认为比传统功能参数更敏感，因为它考虑了后负荷和心肌变形。然而，许多研究仅限于评估整体MW指标，而忽略了与高血压及随之而来的心脏重塑相关的心脏区域差异。我们旨在量化儿童高血压患者的局部MW，并比较肾性或肾血管性高血压（RHTN）与原发性高血压（EHTN）的研究结果。
我们回顾性评估了78例EHTN和RHTN患者（49例男性，年龄15.4±2.94岁）的左心室功能传统标志物以及整体和局部MW指标。
与EHTN相比，RHTN患者基底间隔节段的收缩期峰值应变（PSS）显著受损（-13.00%[-15.50%；-13.00%]对-15.00%[-17.50%；-13.50%]，P = 0.034）。同样，与RHTN相比，EHTN患者的基底间隔MW指标显著升高，包括MW效率（MWE）（95.0%[93.0%；98.0%]对94.0%[89.0%；95.0%]，P = 0.004）和建设性做功（CW）（1700 mmHg%（409 mmHg%）对1520 mmHg%（336 mmHg%），P = 0.037）。RHTN组的废功（WW）显著升高（79.0 mmHg%[28.5 mmHg%；104 mmHg%]对105 mmHg%[62.0 mmHg%；164 mmHg%]，P = 0.010）。
EHTN和RHTN之间在基底间隔PSS和MW指标上存在显著差异。这些发现突出了局部MW指标在评估疾病中的有用性，并可能有助于区分儿童高血压的病因。
