Gardin J M, Arnold A, Gottdiener J S, Wong N D, Fried L P, Klopfenstein H S, O'Leary D H, Tracy R, Kronmal R
Department of Medicine, University of California, Irvine, USA.
Hypertension. 1997 May;29(5):1095-103. doi: 10.1161/01.hyp.29.5.1095.
Left ventricular (LV) mass, as estimated from M-mode echocardiography (echo), has previously been shown to be an independent predictor of incident cardiovascular disease morbidity and mortality. We evaluated the relationship at baseline of echo LV mass to relevant cardiovascular disease risk factors and other potential covariates in the Cardiovascular Health Study, multicenter study sponsored by the National Heart, Lung, and Blood Institute of 5201 men and women aged 65 years or older (mean, 73). Two-dimensionally directed M-mode echo LV mass measurements could be obtained in 1357 men and 2053 women (66% of this elderly cohort). Stepwise linear regression analyses of the relationship of echo LV mass to demographic and risk factor, physical activity, electrocardiographic, and prevalent disease variables resulted in a model that explained 37% of the variance for the entire cohort. In order of decreasing importance, factors positively associated with echo LV mass were body weight, male sex, systolic pressure, presence of congestive heart failure, present smoking, major and minor electrocardiographic abnormalities, treatment for hypertension, valvular heart disease, aortic regurgitation by color Doppler, and mitral regurgitation by color Doppler (in men) whereas diastolic pressure, bioresistance (a measure of adiposity), and high-density lipoprotein cholesterol were inversely related to echo LV mass. Although height and weight were both related to LV mass, height added nothing once weight was entered in multiple linear regression analyses. Furthermore, in the multiple regression models, diastolic pressure was inversely and systolic BP positively related to LV mass, with similar magnitudes for their coefficients. In consonance with these findings, pulse pressure was positively related to LV mass in bivariate analyses. Multiple linear regression analyses explained less of the variance for ventricular septal thickness (R2 = .13) and LV posterior wall thickness (R2 = .14) than for LV mass (R2 = .37) and LV diastolic dimension (R2 = .27). Intriguing findings in the elderly Cardiovascular Health Study cohort included the presence of pulse pressure as a positive correlate, and high-density lipoprotein cholesterol as an inverse correlate, of LV mass. Longitudinal studies in the Cardiovascular Health Study cohort will help to clarify the importance of demographic, risk factor, and other variables, and changes in these variables, in predicting changes in echo LV mass and its components as well as the prognostic significance of LV mass in the elderly.
以往研究表明，通过M型超声心动图（超声）估算的左心室（LV）质量是心血管疾病发病和死亡的独立预测指标。在由美国国立心肺血液研究所赞助的心血管健康研究中，我们评估了超声LV质量在基线时与相关心血管疾病危险因素及其他潜在协变量之间的关系。该研究为多中心研究，纳入了5201名65岁及以上（平均73岁）的男性和女性。在1357名男性和2053名女性（占该老年队列的66%）中获得了二维导向的M型超声LV质量测量值。对超声LV质量与人口统计学和危险因素、体力活动、心电图及常见疾病变量之间关系进行逐步线性回归分析，得到一个模型，该模型解释了整个队列中37%的方差。按重要性递减顺序，与超声LV质量呈正相关的因素依次为体重、男性、收缩压、充血性心力衰竭、当前吸烟、主要和次要心电图异常、高血压治疗、瓣膜性心脏病、彩色多普勒显示的主动脉反流以及彩色多普勒显示的二尖瓣反流（男性）；而舒张压、生物电阻抗（肥胖指标）和高密度脂蛋白胆固醇与超声LV质量呈负相关。虽然身高和体重均与LV质量相关，但在多元线性回归分析中，一旦纳入体重，身高就不再具有预测价值。此外，在多元回归模型中，舒张压与LV质量呈负相关，收缩压与LV质量呈正相关，且二者系数大小相似。与这些发现一致，在双变量分析中脉压与LV质量呈正相关。多元线性回归分析对室间隔厚度（R2 = 0.13）和LV后壁厚度（R2 = 0.14）方差的解释程度低于对LV质量（R2 = 0.37）和LV舒张期内径（R2 = 0.27）方差的解释程度。在老年心血管健康研究队列中的有趣发现包括脉压与LV质量呈正相关，高密度脂蛋白胆固醇与LV质量呈负相关。在心血管健康研究队列中的纵向研究将有助于阐明人口统计学、危险因素和其他变量及其变化在预测超声LV质量及其组成部分变化以及LV质量在老年人中的预后意义方面的重要性。
