Marcus R, Krause L, Weder A B, Dominguez-Meja A, Schork N J, Julius S
Department of Internal Medicine, University of Michigan, Ann Arbor.
Circulation. 1994 Aug;90(2):928-36. doi: 10.1161/01.cir.90.2.928.
Left ventricular hypertrophy (LVH) defined by either ECG or echocardiographic criteria is a risk factor for cardiovascular morbidity and mortality. A number of determinants of LVH have been described in previous studies, principally male sex, hypertension, obesity, and aortic valvular stenosis. We examined the distribution of LV mass (LVM) in a population of 18- to 42-year-old normotensive men and women who were free of valvular heart disease to establish sex-specific normal values for LVM index (LVMI) and to determine the correlates of LVMI.
LVM was derived from measurements obtained by M-mode echocardiography. Average LVMI is significantly greater in men (102.9 +/- 0.7 g/m2) than women (88.2 +/- 0.7 g/m2). By defining LVH as an LVMI greater than the 90th percentile, we developed sex-specific criteria for LVH: men, > 125.4 g/m2; women, > 110 g/m2. We found that LVH in men is associated with indices of enhanced sympathetic nervous system reactivity and with elevated fasting insulin and triglyceride levels, which may be caused by insulin resistance. In women, LVH was associated with higher body weight and obesity.
Before the onset of hypertension, increased LVMI appears to have different determinants in men and women. We suggest that early LVH in young men is a manifestation of hyperkinetic borderline hypertension, a state previously shown to be associated with increased sympathetic nervous system activity and insulin resistance. The hyperkinetic state is less prevalent in young women, in whom increased adiposity seems to be the predominant factor associated with LVH.
通过心电图或超声心动图标准定义的左心室肥厚（LVH）是心血管疾病发病和死亡的危险因素。先前的研究已经描述了LVH的许多决定因素，主要是男性、高血压、肥胖和主动脉瓣狭窄。我们研究了18至42岁无瓣膜性心脏病的血压正常的男性和女性人群中左心室质量（LVM）的分布情况，以确定左心室质量指数（LVMI）的性别特异性正常值，并确定LVMI的相关因素。
LVM来自于M型超声心动图测量值。男性的平均LVMI（102.9±0.7g/m²）显著高于女性（88.2±0.7g/m²）。通过将LVH定义为LVMI大于第90百分位数，我们制定了LVH的性别特异性标准：男性，>125.4g/m²；女性，>110g/m²。我们发现男性的LVH与交感神经系统反应性增强的指标以及空腹胰岛素和甘油三酯水平升高有关，这可能是由胰岛素抵抗引起的。在女性中，LVH与更高的体重和肥胖有关。
在高血压发病之前，男性和女性的LVMI增加似乎有不同的决定因素。我们认为年轻男性早期的LVH是高动力型临界高血压的一种表现，这种状态先前已被证明与交感神经系统活动增加和胰岛素抵抗有关。高动力状态在年轻女性中不太常见，在她们中，肥胖增加似乎是与LVH相关的主要因素。
