Manolas J
Diagnostic and Therapeutic Center of Athens 'HYGEIA', Greece.
Cardiology. 1997 Jan-Feb;88(1):36-47. doi: 10.1159/000177307.
This study was undertaken to determine the prevalence and distribution of diastolic function abnormalities at rest and during isometric exercise in patients with systemic hypertension using the recently introduced handgrip-apexcardiographic test (HAT). It has been shown that HAT reflects left ventricular pressure changes in early (relaxation) and late (compliance) diastole. A HAT was obtained in 132 patients with systemic hypertension (duration >1 year) without history of congestive heart failure. A healthy group (n = 186) served as control subjects. Diastolic abnormalities were present at rest in 53/132 (40%) and during isometric handgrip stress in 92/132 (70%) patients. At rest the most frequent diastolic abnormality was the prolongation of relaxation time (27%) whereas an isolated increase in A wave was rare (8%). During isometric exercise, however, an elevation of A wave was the predominant abnormality (38%) whereas an isolated prolongation of relaxation time was less frequent (14%). Alternatively, an 'ischemic' pattern (abnormal prolongation of resting normal relaxation time during handgrip and/or abnormal as well as more than double increase of resting normal relative A wave to total height during or after handgrip) was observed in 29%. In 89% of these patients with an ischemic pattern of diastolic changes, a typical angina and/or positive stress ECG and/or angiographically proved coronary artery disease were present. Using HAT data the present study demonstrates for the first time that in patients with systemic hypertension: (1) diastolic abnormalities occur significantly more frequently during isometric stress than at rest, (2) the most frequently observed diastolic abnormality at rest is the relaxation time prolongation whereas during isometric stress the A wave elevation, and (3) patients with an ischemic pattern of exercise-induced diastolic abnormalities show frequently clinical or angiographic evidence of demand ischemia. Thus, HAT can become a useful additional diagnostic tool for detecting latent diastolic dysfunction and myocardial ischemia in this clinical setting.
本研究旨在使用最近引入的握力-心尖心动图测试（HAT），确定系统性高血压患者静息和等长运动期间舒张功能异常的患病率及分布情况。研究表明，HAT可反映舒张早期（松弛）和晚期（顺应性）的左心室压力变化。对132例无充血性心力衰竭病史的系统性高血压患者（病程>1年）进行了HAT检测。选取186名健康人群作为对照组。132例患者中，53例（40%）静息时存在舒张功能异常，92例（70%）在等长握力应激时存在舒张功能异常。静息时最常见的舒张功能异常是舒张时间延长（27%），而单纯A波增高少见（8%）。然而，在等长运动期间，A波升高是主要异常（38%），而单纯舒张时间延长较少见（14%）。另外，29%的患者出现“缺血”模式（握力时静息正常舒张时间异常延长和/或握力期间或之后静息正常相对A波至总高度异常增加且超过两倍）。在这些舒张变化呈缺血模式的患者中，89%存在典型心绞痛和/或阳性运动心电图和/或血管造影证实的冠状动脉疾病。本研究首次利用HAT数据表明，系统性高血压患者：（1）等长应激时舒张功能异常的发生率显著高于静息时；（2）静息时最常观察到的舒张功能异常是舒张时间延长，而等长应激时是A波升高；（3）运动诱发舒张功能异常呈缺血模式的患者常伴有需求性心肌缺血的临床或血管造影证据。因此，在这种临床情况下，HAT可成为检测潜在舒张功能障碍和心肌缺血的有用辅助诊断工具。
