Mureddu G F, de Simone G, Greco R, Rosato G F, Contaldo F
Department of Clinical and Experimental Medicine, Federico II University Hospital School of Medicine, Naples, Italy.
Hypertension. 1997 Feb;29(2):544-50. doi: 10.1161/01.hyp.29.2.544.
We assessed the relations of left ventricular filling to load and geometry by Doppler echocardiography in 80 normotensive subjects (40 normal-weight [36 +/- 12 years, 24 women] and 40 obese [35 +/- 13 years, 24 women]) and 61 hypertensive subjects without silent coronary heart disease (29 normal-weight [43 +/- 13 years, 15 women] and 32 obese [42 +/- 13 years, 19 women]) and comparable left ventricular midwall performance. Left ventricular mass divided by height to the 2.7 power was higher in all groups than in normotensive normal-weight subjects (all P < .0001) and in hypertensive than normotensive obese subjects (P < .001). After controlling for age, sex, blood pressure, and heart rate, isovolumic relaxation time was prolonged in hypertensive subjects and normotensive obese subjects compared with normotensive normal-weight subjects (all P < .0001). Body mass index, left ventricular dimension and mass, and circumferential end-systolic stress did not influence these differences. In pooled groups, prolonged isovolumic relaxation time was predicted by high mean blood pressure (beta = 0.52, P < .001), low end-systolic stress (beta = -0.33, P < .001), increased left ventricular mass (beta = 0.24, P < .004), and high body mass index (beta = 0.14, P < .05, multiple R = .72, SEE = 16.5 milliseconds, P < .0001). Between-group differences in peak early transmitral flow velocity, the deceleration time of early filling velocity, and the ratio of early to late left ventricular filling disappeared after controlling for left ventricular mass. Thus, (1) isovolumic relaxation time is prolonged in both arterial hypertension and obesity; (2) the presence of obesity does not significantly increase isovolumic relaxation time in hypertension; and (3) abnormalities of left ventricular filling in arterial hypertension are offset after controlling for left ventricular mass.
我们通过多普勒超声心动图评估了80名血压正常受试者（40名正常体重者[年龄36±12岁，女性24名]和40名肥胖者[年龄35±13岁，女性24名]）以及61名无隐匿性冠心病的高血压受试者（29名正常体重者[年龄43±13岁，女性15名]和32名肥胖者[年龄42±13岁，女性19名]）左心室充盈与负荷及几何形态的关系，并比较了左心室中层心肌的功能。所有组的左心室质量除以身高的2.7次方均高于血压正常的正常体重受试者（均P<0.0001），且高血压组高于血压正常的肥胖受试者（P<0.001）。在控制年龄、性别、血压和心率后，与血压正常的正常体重受试者相比，高血压受试者和血压正常的肥胖受试者的等容舒张时间延长（均P<0.0001）。体重指数、左心室尺寸和质量以及圆周收缩末期应力并未影响这些差异。在合并组中，平均血压升高（β=0.52，P<0.001）、收缩末期应力降低（β=-0.33，P<0.001）、左心室质量增加（β=0.24，P<0.004）以及体重指数升高（β=0.14，P<0.05，复相关系数R=0.72，标准误=16.5毫秒，P<0.0001）可预测等容舒张时间延长。在控制左心室质量后，各组间二尖瓣早期血流峰值速度、早期充盈速度减速时间以及左心室早期与晚期充盈比值的差异消失。因此，（1）动脉高血压和肥胖均会使等容舒张时间延长；（2）肥胖的存在并不会显著增加高血压患者的等容舒张时间；（3）在控制左心室质量后，动脉高血压患者左心室充盈异常可得到抵消。
