Grandi A M, Venco A, Sessa F, Gola A, Pantaleo P, Gobbi G, Baiardini R, Finardi G
Department of Internal Medicine and Medical Therapy--University of Pavia, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
Am J Hypertens. 1993 Aug;6(8):708-12. doi: 10.1093/ajh/6.8.708.
Using digitized M-mode echocardiograms, we evaluated the determinants of left ventricular (LV) systolic and diastolic function in 30 hypertensives with LV hypertrophy (LV mass > 230 g and normal LV diastolic diameter), before (LV mass 319 +/- 26 g) and after normalization of LV mass (196 +/- 21 g) by antihypertensive treatment with angiotensin converting enzyme inhibitors. As a control group we selected 50 normal subjects. Using multiple regression analysis we studied the relative role of preload (LV end-diastolic diameter), afterload (end-systolic wall stress), inotropic state (systolic pressure/end-systolic LV diameter ratio), and LV mass on LV systolic (peak shortening rate of LV diameter) and diastolic function (peak lengthening rate of LV diameter). The major determinant of systolic function was the end-systolic stress in hypertensives before treatment and the systolic pressure/end-systolic LV diameter ratio in normals and in hypertensives after treatment. The major determinant of diastolic function was LV mass in hypertensives before treatment and end-systolic stress in normals and in hypertensives after normalization of LV mass by treatment. Preload seems not to influence LV function in normals and in hypertensives with normal LV diameter. The inotropic state is the major determinant of systolic function in normals and in hypertensives after treatment, whereas this role is played by afterload in hypertensives before treatment. The diastolic function is primarily influenced by after-load in normals and in hypertensives after regression of myocardial hypertrophy, whereas in hypertensives with myocardial hypertrophy LV mass is the major determinant of diastolic function.
利用数字化M型超声心动图，我们评估了30例左心室肥厚（左心室质量>230 g且左心室舒张直径正常）高血压患者在使用血管紧张素转换酶抑制剂进行抗高血压治疗前（左心室质量319±26 g）和左心室质量恢复正常后（196±21 g）左心室（LV）收缩和舒张功能的决定因素。我们选择了50名正常受试者作为对照组。通过多元回归分析，我们研究了前负荷（左心室舒张末期直径）、后负荷（收缩末期壁应力）、心肌收缩力状态（收缩压/收缩末期左心室直径比值）和左心室质量对左心室收缩功能（左心室直径峰值缩短率）和舒张功能（左心室直径峰值延长率）的相对作用。治疗前高血压患者收缩功能的主要决定因素是收缩末期应力，而正常人和治疗后高血压患者的主要决定因素是收缩压/收缩末期左心室直径比值。治疗前高血压患者舒张功能的主要决定因素是左心室质量，而正常人和经治疗左心室质量恢复正常后的高血压患者的主要决定因素是收缩末期应力。前负荷似乎对正常人和左心室直径正常的高血压患者的左心室功能没有影响。心肌收缩力状态是正常人和治疗后高血压患者收缩功能的主要决定因素，而在治疗前高血压患者中后负荷起这一作用。在正常人和心肌肥厚消退后的高血压患者中，舒张功能主要受后负荷影响，而在有心肌肥厚的高血压患者中，左心室质量是舒张功能的主要决定因素。
