Starc T J, Bierman F Z, Pavlakis S G, Challenger M E, De Vivo D C, Gersony W M
Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York 10032.
Am J Cardiol. 1994 Jan 1;73(1):57-64. doi: 10.1016/0002-9149(94)90727-7.
The effects of adrenocorticotropic hormone (ACTH) on systolic blood pressure, and echocardiographic indexes of heart size and function were investigated in 14 infants. After 25 days (range 13 to 46) of treatment with ACTH, systolic blood pressure increased from 93 +/- 9 to 118 +/- 20 mm Hg (p < 0.001; mean +/- 1 SD). Systolic hypertension (systolic blood pressure greater than the 95th percentile for age) developed in 10 of 14 infants and was associated with an increase in left ventricular (LV) shortening fraction from 41 +/- 5% to 52 +/- 8% (p < 0.001). Myocardial hypertrophy and an increase in echocardiographic indexes of myocardial contractility were observed also. To assess the temporal relation between the onset of systolic hypertension and these cardiac changes, data from 8 infants with serial echocardiograms and blood pressure determinations were examined. After a mean 14 days (range 8 to 18) of ACTH, LV shortening fraction increased from 39 +/- 6% to 53 +/- 8% (p < 0.01), whereas systolic blood pressure remained normal in 7 of 8 infants. In addition, a decrease in LV end-systolic dimension was observed during this early phase. This report documents myocardial changes in individual patients, which occur before and during the development of systolic hypertension.
在14名婴儿中研究了促肾上腺皮质激素（ACTH）对收缩压以及心脏大小和功能的超声心动图指标的影响。在接受ACTH治疗25天（范围13至46天）后，收缩压从93±9 mmHg升高至118±20 mmHg（p<0.001；均值±1标准差）。14名婴儿中有10名出现收缩期高血压（收缩压高于年龄的第95百分位数），并且与左心室（LV）缩短分数从41±5%增加到52±8%相关（p<0.001）。还观察到心肌肥厚以及心肌收缩力的超声心动图指标增加。为了评估收缩期高血压发作与这些心脏变化之间的时间关系，检查了8名有系列超声心动图和血压测定数据的婴儿的数据。在平均接受ACTH治疗14天（范围8至18天）后，LV缩短分数从39±6%增加到53±8%（p<0.01），而8名婴儿中有7名的收缩压仍保持正常。此外，在此早期阶段观察到LV舒张末期内径减小。本报告记录了个体患者在收缩期高血压发生之前和期间出现的心肌变化。
