Aurigemma G P, Gaasch W H, McLaughlin M, McGinn R, Sweeney A, Meyer T E
Division of Cardiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Am J Cardiol. 1995 Oct 1;76(10):702-5. doi: 10.1016/s0002-9149(99)80201-x.
We studied the relation between relative wall thickness, left ventricular systolic pump performance, and myocardial contractile function in 77 older patients with normal ejection fraction who were free of valvular and myocardial ischemic disease. Group 1 comprised 49 patients with relative wall thickness > or = 0.45; group 2 (n = 28) had normal relative wall thickness. Pump performance was characterized by stroke volume index, cardiac index, and stroke work; myocardial function was characterized by midwall shortening and circumferential stress versus shortening relations. Group 1 patients had lower end-diastolic volume (83 +/- 3 vs 124 +/- 5 ml, p < 0.05), cardiac index (2.6 +/- 0.2 vs 3.5 +/- 0.1 L/min/m2, p < 0.05), and stroke work/100 g left ventricular mass (43 +/- 2 vs 53 +/- 3 g-m/100 g, p < 0.005). Although there was no significant difference with regard to ejection fraction or fractional shortening at the endocardium, fractional shortening at the midwall was significantly lower in group 1 than in group 2 (16 +/- 1% vs 19 +/- 1%, p < 0.005). This lower value for midwall shortening was observed despite lower values for endsystolic stress, implying decreased myocardial contractile function. Lower stroke volume index in group 1 patients, likely due to small chamber size, was not offset by increased heart rate, resulting in a low-normal cardiac index; in 33% of group 1 patients, cardiac index was < 2.2 L/min/m2, indicating reduced pump performance. Our data indicate an abnormality in pump performance and myocardial function in patients who have high relative wall thickness and normal ejection fraction.
我们研究了77例射血分数正常、无瓣膜和心肌缺血性疾病的老年患者的相对室壁厚度、左心室收缩泵功能和心肌收缩功能之间的关系。第1组包括49例相对室壁厚度≥0.45的患者；第2组（n = 28）相对室壁厚度正常。泵功能以每搏量指数、心指数和每搏功来表征；心肌功能以室壁中层缩短率以及圆周应力与缩短率的关系来表征。第1组患者的舒张末期容积较低（83±3 vs 124±5 ml，p<0.05）、心指数较低（2.6±0.2 vs 3.5±0.1 L/min/m²，p<0.05）以及每搏功/100 g左心室质量较低（43±2 vs 53±3 g·m/100 g，p<0.005）。尽管在心内膜处射血分数或缩短分数无显著差异，但第1组的室壁中层缩短率显著低于第2组（16±1% vs 19±1%，p<0.005）。尽管收缩末期应力较低，但仍观察到室壁中层缩短率较低，这意味着心肌收缩功能降低。第1组患者每搏量指数较低，可能是由于心室腔较小，未被心率增加所抵消，导致心指数略低于正常；在第1组33%的患者中，心指数<2.2 L/min/m²，表明泵功能降低。我们的数据表明，相对室壁厚度高且射血分数正常的患者存在泵功能和心肌功能异常。
