Urbina E M, Gidding S S, Bao W, Pickoff A S, Berdusis K, Berenson G S
Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112-7103, USA.
Circulation. 1995 May 1;91(9):2400-6. doi: 10.1161/01.cir.91.9.2400.
The measurement of left ventricular mass (LVM) is important because individuals with increased LVM are at increased risk for cardiovascular diseases, including myocardial infarction and congestive heart failure. There are limited longitudinal data on the acquisition of LVM in children and young adults and the relative importance of sex, growth, excess body weight, and blood pressure (BP) on change in LVM.
The study cohort consisted of a cross section of 160 healthy children and young adults 9 to 22 years of age at first exam in the biracial community of Bogalusa, La. All had stable BP levels recorded over a 2- to 3-year period. Repeated examinations were performed 4 to 5 years apart. At each exam, 6 BPs were obtained with a mercury sphygmomanometer by trained examiners. The mean of the observations was used, with the fourth Korotkoff phase serving as the measure of diastolic BP. Anthropometric data, including height (HT), weight (WT), and triceps skin fold thickness (TSF), were also obtained, and M-mode echocardiograms were performed. Ponderal index (PI = WT/HT3) was used as a measure of weight-for-height. Tracking of HT (r = .68 to .76), WT (r = .73 to .82), PI (r = .77 to .89), TSF (r = .70 to .80), BP (r = .47 to .60), and LVM (r = .40 to .70) was strong in both sexes (P < .0001). LVM indexed for linear growth (LVM/HT2.7) tracked in females (r = .56, P < .0001) but not in males. In univariate cross-sectional analyses, LVM/HT2.7 correlated with WT, PI, and TSF in both sexes (r = .21 to .60, P < .05) and with systolic BP (SBP) in females (r = .23, P < .05). WT was the only independent correlate of LVM/HT2.7 in both sexes in multivariate cross-sectional analysis in a model containing age, SBP, WT, and TSF as independent variables (r2 = .08 to .28, P < .02). In longitudinal univariate analyses, initial measurements of WT, PI, and TSF predicted final LVM/HT2.7 in both sexes (r = .28 to .56, P < .01), and SBP was significant for females (r = .27, P < .05). In multivariate analyses, initial WT was associated with final LVM and LVM/HT2.7 in both sexes (r2 = .27 to .54, P < .01). Finally, baseline LVM correlated with final SBP in both sexes (r = .21 to .27, P < .05), and initial LVM/HT2.7 correlated with final SBP in females (r = .26, P < .05) with a trend for males (r = .17).
These data indicate that linear growth is the major determinant of cardiac growth in children and that excess weight may lead to the acquisition of LVM beyond that expected from normal growth. Increased mass may also precede the development of increased BP. The development of obesity may therefore be a significant, and possibly modifiable, risk factor for developing left ventricular hypertrophy and hypertension, risk factors for cardiovascular morbidity and mortality.
左心室质量（LVM）的测量很重要，因为LVM增加的个体患心血管疾病（包括心肌梗死和充血性心力衰竭）的风险会增加。关于儿童和年轻人LVM的获取以及性别、生长、超重和血压（BP）对LVM变化的相对重要性的纵向数据有限。
研究队列包括路易斯安那州博加卢萨混血社区160名9至22岁首次接受检查的健康儿童和年轻人的横断面样本。所有人在2至3年期间记录了稳定的血压水平。每隔4至5年进行一次重复检查。每次检查时，由训练有素的检查人员使用汞柱式血压计测量6次血压。采用观察值的平均值，以柯氏音第四相作为舒张压的测量值。还获取了人体测量数据，包括身高（HT）、体重（WT）和肱三头肌皮褶厚度（TSF），并进行了M型超声心动图检查。体质指数（PI = WT/HT3）用作身高体重比的指标。身高（r = 0.68至0.76）、体重（r = 0.73至0.82）、PI（r = 0.77至0.89）、TSF（r = 0.70至0.80）、血压（r = 0.47至0.60）和LVM（r = 0.40至0.70）在两性中均具有很强的追踪性（P < 0.0001）。以线性生长指数化的LVM（LVM/HT2.7）在女性中具有追踪性（r = 0.56，P < 0.0001），但在男性中没有。在单变量横断面分析中，LVM/HT2.7在两性中均与WT、PI和TSF相关（r = 0.21至0.60，P < 0.05），在女性中与收缩压（SBP）相关（r = 0.23，P < 0.05）。在包含年龄、SBP、WT和TSF作为自变量的多变量横断面分析中，WT是两性中LVM/HT2.7的唯一独立相关因素（r2 = 0.08至0.28，P < 0.02）。在纵向单变量分析中，WT、PI和TSF的初始测量值可预测两性的最终LVM/HT2.7（r = 0.28至0.56，P < 0.01），SBP对女性有显著意义（r = 0.27，P < 0.05）。在多变量分析中，初始WT与两性的最终LVM和LVM/HT2.7相关（r2 = 0.27至0.
