Kimball T R, Daniels S R, Loggie J M, Khoury P, Meyer R A
Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229.
J Am Coll Cardiol. 1993 Mar 15;21(4):997-1001. doi: 10.1016/0735-1097(93)90359-9.
The aim of this study was to determine if left ventricular preload, afterload or contractility is a correlate of left ventricular mass index in hypertensive pediatric patients.
It is believed that decreased contractility and increased preload are associated with left ventricular hypertrophy in adult hypertensive patients.
Ninety pediatric hypertensive patients underwent echocardiography to assess left ventricular mass, preload (diastolic dimension and volume) and afterload (end-systolic wall stress, vascular resistance and blood pressure). Contractility was assessed by 1) the end-systolic stress/volume ratio, and 2) the difference between measured and predicted velocity of circumferential fiber shortening. Univariate and multivariate analyses were performed.
Univariate analysis showed significant correlations between left ventricular mass and 1) body mass (r = 0.33, p < 0.001), 2) black race (r = 0.37, p < 0.0003), 3) diastolic dimension (r = 0.26, p < 0.01), 4) diastolic volume (r = 0.20, p < 0.05), and 5) stress/volume ratio (r = -0.53, p < 0.0001) but not the difference between measured and predicted velocity of circumferential fiber shortening. A multivariate model included body mass, age at diagnosis, diastolic dimension, wall stress and vascular resistance but not the difference between measured and predicted velocity of circumferential fiber shortening.
Contractility is not significantly related to left ventricular mass. The positive correlation between mass and stress/volume may be due to the dependence of the latter variable on loading conditions. We speculate that both elevated preload and systemic vascular resistance may have a role in the development of hypertrophy in hypertensive pediatric patients.
本研究旨在确定左心室前负荷、后负荷或收缩力是否与高血压儿科患者的左心室质量指数相关。
据信，成年高血压患者的收缩力降低和前负荷增加与左心室肥厚有关。
90例儿科高血压患者接受了超声心动图检查，以评估左心室质量、前负荷（舒张期尺寸和容积）和后负荷（收缩末期壁应力、血管阻力和血压）。收缩力通过以下两种方法评估：1）收缩末期应力/容积比；2）圆周纤维缩短实测速度与预测速度之差。进行了单变量和多变量分析。
单变量分析显示左心室质量与以下因素之间存在显著相关性：1）体重（r = 0.33，p < 0.001）；2）黑人种族（r = 0.37，p < 0.0003）；3）舒张期尺寸（r = 0.26，p < 0.01）；4）舒张期容积（r = 0.20，p < 0.05）；5）应力/容积比（r = -0.53，p < 0.0001），但与圆周纤维缩短实测速度与预测速度之差无关。多变量模型包括体重、诊断年龄、舒张期尺寸、壁应力和血管阻力，但不包括圆周纤维缩短实测速度与预测速度之差。
收缩力与左心室质量无显著相关性。质量与应力/容积之间的正相关可能是由于后一个变量对负荷条件的依赖性。我们推测，前负荷升高和全身血管阻力升高可能在高血压儿科患者肥厚的发展中起作用。
