Cohen-Solal A, Caviezel B, Himbert D, Gourgon R
Service de Cardiologie, Hôpital Beaujon, Clichy, France.
J Hypertens. 1994 May;12(5):591-600.
To clarify the spectrum of the left ventricular responses in hypertension in man by means of coupled analysis of elastances. In the present study we analysed the 'functional' coupling of the left ventricle and the arterial system in terms of the arterial effective elastance (E(a)) divided by a value of end-systolic left ventricular elastance approximated by the end-systolic pressure-volume ratio (E(lv)).
Twenty-five normotensive and 19 hypertensive males without heart failure underwent a haemodynamic and angiographic study. The hypertensives were divided into three subgroups: group 1 had normal ejection fraction, group 2 had ejection fraction > 70% and group 3 had ejection fraction 50-58%.
The ejection fraction was similar in hypertensives and controls and E(lv) was significantly increased in the hypertensives. E(a) was identical in the three hypertensive subgroups, which differed only for E(lv). Hypertensives with a normal ejection fraction (n = 8) had a normal E(a)/E(lv) ratio and end-systolic stress, and a significantly increased E(lv), related mainly to an increase in the left ventricular mass divided by the end-diastolic volume (m/VED) with normal systolic function of the left ventricular muscle. The significantly increased systolic pump function of group 2 (n = 5) seems to be related to a significant increase in both m/VED and left ventricular muscle contractility. Group 3 (n = 6) was more heterogeneous, some patients having insufficient hypertrophy and others impaired muscle function.
The left ventricle and the arterial system remain correctly coupled in hypertensives overall, but with marked heterogeneity of the systolic pump (and sometimes muscle) function and mainly of the geometry of the left ventricle. Regarding the relatively unequivocal changes in Ea, the differences in ejection fraction and in left ventricular-arterial coupling in hypertensives are related mainly to changes in the left ventricular systolic pump function.
通过弹性耦联分析来阐明人类高血压患者左心室反应的范围。在本研究中，我们根据动脉有效弹性（E(a)）除以由收缩末期压力-容积比（E(lv)）估算的收缩末期左心室弹性值，分析了左心室与动脉系统的“功能”耦联。
25名无心力衰竭的正常血压男性和19名高血压男性接受了血流动力学和血管造影研究。高血压患者被分为三个亚组：第1组射血分数正常，第2组射血分数>70%，第3组射血分数为50-58%。
高血压患者和对照组的射血分数相似，高血压患者的E(lv)显著增加。三个高血压亚组的E(a)相同，仅在E(lv)方面存在差异。射血分数正常的高血压患者（n = 8）的E(a)/E(lv)比值和收缩末期应力正常，E(lv)显著增加，这主要与左心室质量除以舒张末期容积（m/VED）增加有关，且左心室肌收缩功能正常。第2组（n = 5）收缩泵功能显著增加似乎与m/VED和左心室肌收缩力均显著增加有关。第3组（n = 6）更为异质，一些患者存在肥厚不足，另一些患者存在肌功能受损。
总体而言，高血压患者的左心室与动脉系统仍能正确耦联，但收缩泵（有时是肌）功能以及主要是左心室几何结构存在明显异质性。关于Ea相对明确的变化，高血压患者射血分数和左心室-动脉耦联的差异主要与左心室收缩泵功能的变化有关。
