Soma J, Widerøe T E, Dahl K, Rossvoll O, Skjaerpe T
Department of Medicine, Section of Cardiology, University Hospital of Trondheim, Norway.
J Am Coll Cardiol. 1996 Jul;28(1):190-6. doi: 10.1016/0735-1097(96)00129-5.
The aim of this study was to investigate left ventricular function in subjects with "white coat" hypertension, defined as office arterial diastolic pressure > or = 90 and ambulatory daytime pressures < 140/90 mm Hg.
The white coat arterial pressure response may, by influencing left ventricular function, have a confounding effect in studies of heart disease.
Two-dimensional and Doppler echocardiography combined with the calibrated subclavian arterial pulse tracing, were used to assess variables of left ventricular function in 26 subjects with white coat hypertension (office arterial diastolic pressure > or = 90 and < 115 mm Hg and ambulatory daytime diastolic pressure > or = 90 mm Hg) and 32 normotensive subjects.
In subjects with white coat hypertension, systolic arterial pressure during the echocardiographic examination was significantly higher than ambulatory daytime systolic pressure. This pressure response was positively related to the ratio of the systolic to diastolic pulmonary venous flow peak velocities and to the peak velocity of flow reversion during atrial systole; it was inversely related to the ratio of early to late mitral flow peak velocities. Left ventricular stroke volume, ejection fraction and velocity of circumferential fiber shortening did not differ in the study groups, but left ventricular external work and end-systolic wall stress were increased in the white coat group.
The arterial pressure response in subjects with white coat hypertension is associated with increased left ventricular external work, increased end-systolic wall stress and alterations of left ventricular filling but normal ejection fraction and velocity of circumferential fiber shortening.
本研究旨在调查“白大衣”高血压患者的左心室功能，“白大衣”高血压定义为诊室动脉舒张压≥90mmHg且动态日间血压＜140/90mmHg。
白大衣动脉压反应可能通过影响左心室功能，在心脏病研究中产生混杂效应。
采用二维和多普勒超声心动图结合校准的锁骨下动脉脉搏描记法，评估26例“白大衣”高血压患者（诊室动脉舒张压≥90mmHg且＜115mmHg，动态日间舒张压≥90mmHg）和32例血压正常者的左心室功能变量。
在“白大衣”高血压患者中，超声心动图检查期间的收缩期动脉压显著高于动态日间收缩压。这种压力反应与收缩期与舒张期肺静脉血流峰值速度之比以及心房收缩期血流逆转峰值速度呈正相关；与二尖瓣血流早期与晚期峰值速度之比呈负相关。研究组间左心室搏出量、射血分数和圆周纤维缩短速度无差异，但“白大衣”组左心室外部做功和收缩末期壁应力增加。
“白大衣”高血压患者的动脉压反应与左心室外部做功增加、收缩末期壁应力增加以及左心室充盈改变有关，但射血分数和圆周纤维缩短速度正常。
