Borer J S, Jason M, Devereux R B, Fisher J, Green M V, Bacharach S L, Pickering T, Laragh J H
Am J Med. 1983 Sep 26;75(3A):34-9. doi: 10.1016/0002-9343(83)90115-8.
Assessment of left ventricular function may be of value in patients with pressure-loaded, hypertrophied left ventricles for the purpose of characterizing such patients as to prognostic risk. To determine whether left ventricular function is in part independent of loading stresses in such patients, and to assess the effects of removal of loading factors, we have reviewed preliminary data in 60 patients with essential hypertension and in 26 patients with aortic stenosis who were studied with radionuclide cineangiography. Patients with hypertension manifested a poor but statistically significant direct relationship between systolic arterial pressure and left ventricular ejection fraction at rest, and a poor but significant inverse relationship between systolic pressure and the magnitude of change in ejection fraction from rest to exercise. However, a strong correlation existed between echocardiographic systolic fractional shortening and end-systolic wall stress at rest. Nonetheless, many patients with normal fractional shortening-end-systolic wall stress relationships had subnormal ejection fraction responses during exercise; the two patients with subnormal fractional shortening-end-systolic wall stress relationships at rest also had subnormal fractional shortening-end-systolic wall stress relationships during exercise. Arterial pressure alone was not predictive of these functional responses. These data suggest that hypertensive patients can be categorized on the basis of left ventricular function at rest and during exercise, independent of arterial pressure. Among patients with aortic stenosis, ejection fraction at rest averaged 67 percent before valve replacement (normal = 57 percent, p less than 0.01), and changed little after operation (71 percent, not significant). However, potential functional benefits of afterload reduction in the patient with the chronically pressure-loaded, hypertrophied left ventricle was suggested by results during exercise: before surgery the ejection fraction during exercise averaged 56 percent (normal = 71 percent, p less than 0.01), but after valve replacement it rose to 72 percent (not significant versus normal). Thus, our data in patients with aortic stenosis supplement our data in patients with hypertension, indicating that myocardial functional improvement can be achieved by unloading therapy in patients with long-standing left ventricular pressure-loading and hypertrophy.
对于压力负荷增加、左心室肥厚的患者，评估左心室功能可能有助于将此类患者按预后风险进行分类。为了确定在此类患者中左心室功能是否部分独立于负荷压力，并评估去除负荷因素的效果，我们回顾了60例原发性高血压患者和26例主动脉瓣狭窄患者的初步数据，这些患者均接受了放射性核素心血管造影检查。高血压患者静息时收缩压与左心室射血分数之间存在较差但具有统计学意义的直接关系，收缩压与静息到运动时射血分数变化幅度之间存在较差但显著的负相关关系。然而，静息时超声心动图收缩期缩短分数与收缩末期壁应力之间存在很强的相关性。尽管如此，许多静息时缩短分数-收缩末期壁应力关系正常的患者运动时射血分数反应仍低于正常；静息时缩短分数-收缩末期壁应力关系低于正常的两名患者运动时缩短分数-收缩末期壁应力关系也低于正常。仅动脉压并不能预测这些功能反应。这些数据表明，高血压患者可根据静息和运动时的左心室功能进行分类，而与动脉压无关。在主动脉瓣狭窄患者中，瓣膜置换术前静息射血分数平均为67%（正常为57%，p<0.01），术后变化不大（71%，无显著性差异）。然而，运动结果提示，对于长期压力负荷增加、左心室肥厚的患者，降低后负荷可能具有潜在的功能益处：手术前运动时射血分数平均为56%（正常为71%，p<0.01），但瓣膜置换术后升至72%（与正常相比无显著性差异）。因此，我们在主动脉瓣狭窄患者中的数据补充了在高血压患者中的数据，表明对于长期左心室压力负荷增加和肥厚的患者，通过卸载治疗可实现心肌功能改善。
