Cornell指数对高血压病患者左室构型的诊断价值

目的:观察心电图Cornell指数对高血压病左室肥厚以及左室肥厚不同几何构型的诊断价值。方法:选用本院住院以及门诊高血压病患者96(男50,女46)例,年龄(54±14)岁。根据心脏超声检查的结果,将入选患者分为4组:①正常几何形态(normal geometry,N);②向心性重构(concentric remodeling,CR);③向心性肥厚(concentrichypertrophy,CH);④离心性肥厚(eccentric hypertrophy,EH),观察心电图Cornell指数在各组中的阳性率。结果:Cornell指数均能明显区分正常心脏形态及左心室肥厚;在不同左室肥厚构型中,Cornell电压指数2.8 mV(男)和Cornell电压指数2.0 mV(女)以及Cornell乘积指数2 440 mm/ms能够显著区分CH(阳性率分别为88%、85%和82%)和EH(阳性率分别为62%、60%和62%)(P0.01);Cornell乘积指数2 440 mm/ms(在CR组的阳性率(80%、75%)明显高于EH组(62%、40%)(P0.01)。结论:心电图Cornell电压指数及Cornell乘积指数可较好鉴别高血压病左室肥厚的不同几何构型。     

超声心动图评价年轻成人左室构型及其影响因素

目的 应用超声心动图观察年轻成人左室构型,并评价血压(BP)和肥胖等心血管疾病危险因素对其影响.方法 应用M型超声心动图测量624例年轻成人(年龄23岁～39 岁)收缩期和舒张期左室内径(LVDs和LVDd)及舒张期室间隔和左室后壁厚度(IVSd和LVPWd),计算左室壁相对厚度(LVRWT)和左室质量指数(LVMI),根据LVRWT＞0.42,LVMI男性＞50 g/m2,女性＞47 g/m2将左室几何形态分为正常(normal geometry,NG)组、向心性重构(concentric remodeling,CR)组、离心性肥厚(eccentric hypertrophy,EH)组和向心性肥厚(concentric hypertrophy,CH)组,同时测量血压、空腹血糖和血脂等.应用多变量Logistic回归分析观察肥胖(BMI)和BP等心血管疾病危险因素与左室几何形态的相关性.结果 NG组、CR组、EH组和CH组的发生率分别为61.6%、12.0%、16.7 %和10.2%.与NG组比较,EH组和CH组收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)和空腹血糖(Glu)高于NG组,高密度脂蛋白(HDL-C)低于NG组,上述指标CR组与NG组及EH组与CH组间无统计学意义(P＞0.05).与CR组比较,EH组BMI和肥胖比例明显高于CR组(P＜0.05),CH组的高血压比例高于CR组(P＜0.05),EH组和CH组之间无统计学意义.多变量Logistic回归分析显示:SBP、DBP和BMI均与EH组和CH组相关(P＜0.05),而与CR组无明显相关性.结论 肥胖和高血压可改变年轻成人左室几何形态,对左室发生EH和CH有预测价值,提示早期防治年轻成人肥胖和高血压有重要意义.     

2DSE评价高血压左室心肌收缩期形变的研究

目的应用二维应变超声心动图(2DSE)监测高血压不同左室构造和形态心肌收缩期多种方位上的反应和转变,讨论其临床价值。方法选取2014年2月~2016年3月于海南省人民医院治疗的原发性高血压患者302例,其中正常构型组(NG组)134例、向心性重构组(CR组)78例、向心性肥厚组(CH组)55例、离心性肥厚组(EH组)35例。同时选取健康志愿者30例作为对照组(NC组),对各组实施超声心动图检测。结果 NG组、CR组、CH组和EH组收缩压(SBP)、舒张压(DBP)、室间隔(IVST)、左室后壁厚度(IVPWT)、左室质量(LVM)、左室质量指数(LVMI)、相对室壁厚度(RWT)、左房容积(LAV)和左房容积指数(LAVI)均明显高于NC组(P0.05),其中CH组和EH组SBP、LVM、LVMI、LAV和LAVI最高;CH组和EH组LVEF、FS和Ea明显低于其他组(P0.05);CH组和EH组Sa低于NC组(P0.05);NG组、CR组、CH组和EH组A明显高于NC组(P0.05);CH组和EH组SL、SCMV、SCPM和SCAP明显高于其他组(P0.05),而SRPM明显低于其他组(P0.05);NG组、CR组和CH组明显SRAP明显高于NC组(P0.05);EH组SRMV明显低于NC组、NG组和CR组(P0.05)。结论在心室重新构造的初期以心肌纵向反应变化减缓为主,在左室肥厚时期纵向、周向及径向应变明显减小,所有构造和形态患者左室转变未减弱;2DSE在评估原发性高血压患者左心室心肌功能转变中有重要应用价值。     

心电图诊断高血压不同构型左室肥厚的研究

目的 分析高血压患者不同构型左心室肥厚予以常规心电图检查的诊断特异度和敏感度研究。方法 临床纳入2022年9月至2023年4月我院收治的高血压不同构型左心室肥厚患者230例,全部研究病例根据2018欧洲高血压学会（ESH）/心脏病学会（ESC）标准分析左心室Ganau分型,分为向心型肥厚组（CH）(n=40)、离心型肥厚组（EH）(n=26)、向心型重构组（CR）(n=110)、正常构型组（NG）(n=54),同时根据中国汉族正常成年人超声心动图检测值研究标准（EMINCA）分组,分为CH组（n=26）、EH组（n=80）、CR组（n=26）、NG组（n=98）,分析根据不同的标准分组的左心室构型结果的一致性,分析左心室构型予以心电图检查的诊断特异度和敏感度。结果 根据国际标准分型,CH组、EH组、CR组、NG组心电图诊断左心室肥厚的阳性率分别为32.5%、23.1%、10.0%、7.4%,组间比较差异有统计学意义（P<0.05）;其中与CR组、NG组相比,CH组、EH组的阳性率显著增高,差异有统计学意义（P<0.05）;根据中国EMINCA标准分型,CH组、EH组、CR组...     

超声心动图评价慢性间歇性低氧兔左心室功能的实验研究

目的建立慢性间歇性低氧(CIH)健康雄性新西兰大白兔动物模型,应用超声心动图评价不同左心室几何构型的左心室收缩和舒张功能。方法 65只健康雄性新西兰兔置于CIH舱内建立模拟阻塞性睡眠呼吸暂停综合征(OSAS)动物模型。造模后8周(51只兔)将左心室几何构型分为正常左心室构型(NG)组、向心性左心室重构(CR)组、向心性左心室肥厚组(CH)组和离心性左心室肥厚(EH)组,比较4组左心室收缩、舒张功能参数。结果左心室收缩功能参数:左心室射血分数(LVEF)在CR组、NG组、CH组、EH组依次降低,等容收缩时间(IVCT)、射血时间(ET)在CR组、NG组、CH组、EH组依次增加;二尖瓣环组织多普勒收缩期速度(Sm)在NG组、CR组、CH组、EH组中依次降低。左心室舒张功能参数:舒张期二尖瓣舒张早期峰值流速(E峰)、E/A、二尖瓣环组织多普勒舒张早期速度(IVS-Em)在NG组、EH组、CR组、CH组依次降低,二尖瓣环组织多普勒舒张期晚期速度(IVS-Am)、等容舒张时间(IVRT)、E峰减速时间(DT)在NG组、EH组、CR组、CH组依次升高;Em/Am在CR组、NG组、EH组、CH组依次减低,E/Em依次升高;舒张早期左室内血流播散速度(Vp)在NG组、CR组、EH组、CH组依次降低。结论 CIH早期可影响左心室收缩及舒张功能,EH左心室收缩功能受损明显,CH左心室舒张功能受损明显。     

阻塞性睡眠呼吸暂停综合征患者左室重构及其血压节律分布

目的探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)左室重构(LVR)类型及其血压节律分布。方法因打鼾入我院经多导睡眠仪监测睡眠呼吸暂停指数(AHI)≥5次/h确诊为OSAS的患者89例,同时定点监测血压,次日晨行血生化及超声心动图检查。根据相对室壁厚度(RWT)≥0.42和左室质量指数(LVMI)≥46.7g/m2.7(女)或49.2g/m2.7(男),将左室几何构型分为正常构型组(normal geometry,NG)、向心性重构组(concentric remodeling,CR)、离心性肥厚组(eccentrichypertrophy,EH)和向心性肥厚组(concentric hypertrophy,CH)。结果四种构型的比率分别为NG 20例(22.5%),CR 15例(16.8%),EH 23例(25.8%)及CH 31例(34.9%)。与NG组比较,CR组AHI升高(P<0.05);EH组体重指数(BMI)升高(P<0.05);CH组年龄、BMI、高血压、AHI、血氧饱和度低于90%的睡眠时间占总睡眠时间的百分比(T90)、白天及夜间平均收缩压均升高,最低血氧饱和度(SaO2)降低(P<0.05)。与CR组比较,EH组年龄、BMI均升高,AHI降低(P<0.05);CH组性别、年龄、BMI、高血压、夜间平均收缩压、三酰甘油(TG)及T90均升高(P<0.05)。与EH组比较,CH组高血压发病率升高,最低SO2降低(P<0.05)。夜间收缩和舒张压下降率在4组中均呈非杓型,且差别无统计学意义(P>0.05)。结论 OSAS可引起左室重构,且四种左室构型的血压节律均为非杓型。     

老年原发性高血压患者动态脉压与心电图异常的关系

目的 探讨老年原发性高血压（EH）患者动态脉压与心电图异常的关系.方法 监测50例EH患者的24 h动态血压和常规12导联心电图,按动态脉压分为脉压40～60 mmHg组（A组）242例和脉压＞60 mmHg组（B组）26例,比较两组的24 h动态血压参数和心电图表现.结果 B组的ST-T改变、心律失常、左心室肥厚等心电图异常显著高于A组（P＜0.05）.结论 老年EH患者心电图异常与脉压增大有关.     

超声心动图评价阻塞性睡眠呼吸暂停病人左室舒张功能与左室几何构型的相关性

目的应用超声心动图评价阻塞性睡眠呼吸暂停综合征(OSAS)病人左室舒张功能与不同左室几何构型的相关性。方法选取2010年12月—2012年7月因打鼾等症状就诊于山西医科大学第一医院呼吸科且经夜间多导睡眠检测确诊为OSAS的病人181例,并按照左室几何构型分为正常构型(NG)组、向心性重构(CR)组、向心性肥厚(CH)组及离心性肥厚(EH)组,测量左室舒张功能指标,分析左室舒张功能与左室构型的相关性及其影响因素。结果 CR组、EH组、CH组舒张早期峰值流速(Em)、舒张晚期峰值流速(Am)、Em/Am依次减低,而E/Em依次增高,差异有统计学意义(P0.05)。Em/Am与左室质量指数(LVMI)、相对室壁厚度(RWT)呈负相关(P0.001),E/Em与LVMI、RWT呈正相关(P0.001)。结论 OSAS可致左室构型改变;不同构型中CH舒张功能受损程度最重。     

体质量指数对原发性高血压患者左心室重构的影响

目的探讨体质量指数(BMI)对原发性高血压左心室重构的影响。方法根据中国肥胖问题工作组建议的肥胖界定标准,2014年9月至2016年12月入选莆田学院附属医院原发性高血压患者205例,分为正常体质量组(n=60)、超重组(n=62)和肥胖组(n=83),所有患者均测定空腹血糖、血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及超声心动图的各种参数,计算左心室质量指数(LVMI)。比较3组患者临床资料、超声心动图指标及左心室几何形态。结果 3组患者LVMI由高到低分别是:肥胖组超重组正常体质量组[(56.21±14.94)(49.06±11.63)(42.65±18.18)g/m2.7];校正性别、年龄、收缩压、舒张压及高血压病程后,3组LVMI比较差异有统计学意义(均P0.05)。与正常体质量组比较,超重组向心性肥厚(CH)发生率(32.3%比10.0%,P0.05)较高,而离心性肥厚(EH)发生率(17.7%比8.3%,P0.05)差异无统计学意义,肥胖组CH和EH发生率(24.1%比10.0%和43.4%比8.3%,P0.05)均增高;与超重组相比,肥胖组CH发生率差异无统计学意义(24.1%比32.3%,P0.05),EH发生率(43.4%比17.7%,P0.05)显著增高。多元线性回归分析结果显示,BMI与LVMI独立相关(β=0.389,P0.001);BMI每增加1kg/m2,LVMI增加1.619g/m~(2.7)。结论肥胖较超重对原发性高血压左心室肥厚(LVH)促进作用更明显,两者均提高左心室重构的发生率。     

从未治疗高血压病人的左心室重建与肾功能关系

在一般人群中 ,肾功能随时着年龄增大呈线性下降 ,高血压加速肾功能下降。左室向心性肥厚是高血压严重程度的重要指标。本文研究 195名正常血压 ,6 45名从未治疗的高血压病人的左室结构与年龄相关性肾功能下降之间的关系。高血压病人按左室重量相对室壁厚度 ,分成正常LV(NL ,4 8% ) ,向心性重建 (CR ,19% ) ,向心性肥厚 (CH ,2 2 % ) ,偏心性肥厚(EH ,11% )。用同位素清除法测GFR与有效肾血浆流量 (ERPF)。正常血压与高血压病人GFR与ERPF与年龄呈负相关。BP与LV肥厚与否无明显影响 ,但与年龄相关的GRF下降曲线的斜率 ,在CH与C…     

Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension

To evaluate the value of modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy (LVH) for patients with essential hypertension. A total of 381 patients with essential hypertension diagnosed in our hospital were selected. Using the left ventricle (LV) geometric patterns classified by the American Society of Echocardiography (ASE), we examined the distribution of the modified Cornell criteria of Ravl + S_D (the deepest S wave in 12‐lead ECG) in different geometric patterns and analyzed the correlation of modified Cornell criteria with changes in the LV geometric patterns using multiple linear regression analysis. The distribution of modified Cornell criteria, Sokolow‐Lyon criteria (RV5/V6 + SV1), and Cornell criteria (Ravl + SV3) in gender‐specific hypertensive geometric patterns were significantly different (P ≤ .01 for all). The voltage of Ravl + S_D in male patients showed an increase trend in the normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups, and this increase trend was significantly in the unadjusted model and the adjusted model. The voltages of Ravl + SV3 and RV5/V6 + SV1 of male patients in CR, CH and RH groups showed a gradual increase trend, but the increase trend in CR group has no statistical significance compared to that in NG group (P ≥ .05). The voltages of Ravl + S_D, RV5/V6 + SV1, and Ravl + SV3 in female patients in CR, CH and EH groups showed a trend of increase after decrease in the adjusted model. In conclusion, the modified Cornell criteria could dynamically reflect left ventricular hypertensive geometry of male patients.     

Prevalence and factors associated with left ventricular remodeling in renal artery stenosis

The objective of this study is to evaluate the prevalence, geometric patterns, and factors associated with left ventricular remodeling in patients with renal artery stenosis (RAS). Demographic, clinical, and echocardiographic data were assessed in 77 patients with RAS prior to endovascular stenting. The left ventricular mass index (LVMI) and relative wall thickness were calculated using American Society of Echocardiography (ASE) recommendations. Patients were classified based on LVMI and relative wall thickness into four ventricular remodeling patterns: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Logistic regression was done to investigate the determinants of the different ventricular remodeling patterns. Mean LVMI and relative wall thickness were 118 ± 40 g/m² and 0.45 ± 0.1. Left ventricular hypertrophy was observed in 65%. CH was the most prevalent geometric pattern of remodeling (normal, 16.9%; CR, 18.2%; CH, 40%; EH, 24.6%). Thirty (39%) patients had an abnormal LV systolic function (ejection fraction <55%), with 14 (46%) of them having eccentric hypertrophy. Independent predictor of EH was glomerular filtration rate (odds ratio [OR], 0.943; confidence interval [CI], 0.899–0.989; P = .01). Systolic elevation of blood pressure (OR, 1.030; CI, 1.003–1.058; P = .03) was associated with CH, and elevated diastolic blood pressure was associated with CR (OR, 0.927; CI, 0.867–0.992; P = .02). Patients with RAS have a high prevalence of left ventricular remodeling and LVH. Even though CH was the most prevalent pattern of left ventricular remodeling, EH was commonplace and was associated with renal dysfunction and heart failure.     

The potential prognostic value of ultrasonic characterization (videodensitometry) of myocardial tissue in essential arterial hypertension

BACKGROUND: Left ventricular hypertrophy (LVH) and the geometric shape of the left ventricle are well-established important risk factors for cardiovascular morbidity and mortality in the hypertensive population. Videodensitometry is an alternate echocardiographic approach to the study of myocardial structural and functional alterations in essential hypertension. OBJECTIVES: To analyze the behavior of the ultrasonic videodensitometric parameter for various subgroups of a hypertensive population; first according to the severity of LVH (group A, without LVH; group B, with mild-to-moderate LVH; and group C, with severe LVH) and second according to geometric adaptation of left ventricle to pressure-volume overload of essential hypertension (group NG, normal geometry; group CR, concentric remodeling; group CH, concentric hypertrophy; and group EH, eccentric hypertrophy). METHODS: For 70 male, essential hypertensive patients and 32 normotensive healthy subjects matched for age (58 +/- 7 years) and sex as controls (group N) we performed ambulatory blood pressure measurements for the evaluation of 24 h mean systolic and diastolic blood pressures, conventional two-dimensional Doppler echocardiography to evaluate left ventricular performance and left ventricular mass index, and digitization of left ventricular parasternal long-axis echocardiographic images. For regions of interest selected within the septum and the posterior wall, the mean gray levels were calculated at end-systole and end-diastole. The resulting values were used to estimate the percentage cyclic variation index (CVI). RESULTS: The results according to left ventricular mass index were CVI for septum group N 34.7 + 16.3%; group A - 0.18 +/- 16%, group B - 13 +/- 19%, and group C - 22 +/- 12% (P < 0.001); and CVI of posterior wall, group N 38.2 +/- 15.4%, group A -0.75 +/- 16%, group B -16 +/- 16% and group C -16 +/- 13% (P< 0.001). According to left ventricular geometry CVI for septum were group NG 0.6 +/- 24%, group CR 1.9 +/- 17%; group CH - 25.4 +/- 18%, and group EH -17.1 +/- 20% (P < 0.01). CVI of posterior wall were group NH -5.8 + 24%, group CR 6.4 +/- 23%, group CH -29 +/- 20%, group EH -20 +/- 21 (P < 0.01). CONCLUSIONS: Our results demonstrate that subjects with high left ventricular masses and those with concentric hypertrophy, which have the worst prognostic impacts, have the most significant changes in CVI. Furthermore, videodensitometric findings are quite different even among the subgroups with mild-to-moderate left ventricular hypertrophy and eccentric hypertrophy. Therefore this videodensitometric approach could provide some useful information for better definition of cardiovascular risk in hypertension.     

Impact of Long-Term Burden of Excessive Adiposity and Elevated Blood Pressure From Childhood on Adulthood Left Ventricular Remodeling Patterns : The Bogalusa Heart Study

Background

Cardiovascular risk factors are associated with left ventricular hypertrophy (LVH), but little is known regarding related impact of longitudinal measures of childhood adiposity and LV hemodynamic variables.

Objectives

The aim of this study was to examine the impact of cumulative long-term burden and trends of excessive adiposity and elevated blood pressure (BP) during childhood on adulthood LVH and LV geometric remodeling patterns.

Methods

This longitudinal study consisted of 1,061 adults, age 24 to 46 years, who had been examined 4 or more times for body mass index (BMI) and BP starting in childhood, with a mean follow-up of 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and BP from childhood to adulthood. Four LV geometric types were defined—normal, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH)—all on the basis of LV mass indexed for body height (m^2.7) and relative wall thickness.

Results

Higher values of BMI and systolic and diastolic BP in childhood and adulthood, as well as total AUC and incremental AUC, were all significantly associated with higher LV mass index and LVH, adjusted for race, sex, and age. In addition, higher values of BMI and BP in childhood and adulthood, total AUC, and incremental AUC were significantly associated with EH and CH but not with CR. Importantly, all of these measures of BMI had a consistently and significantly greater influence on EH than did measures of BP.

Conclusions

These findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LVH begins in childhood.     

Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

The aim of the study was to assess the determinants of increased QT interval parameters in diabetic patients with arterial hypertension and, in particular, the strength of their relationships to echocardiographically derived left ventricular mass (LVM) and geometric patterns. In a cross-sectional study with 289 hypertensive type 2 diabetic outpatients, maximal QT and QTc (heart rate-corrected) intervals, and QT, QTc, and number-of-leads-adjusted QT interval dispersions were manually measured from standard baseline 12-lead ECGs. Electrocardiographic criteria for left ventricular hypertrophy (LVH) were either Sokolow-Lyon or Cornell sex-specific voltages. LVM and geometric patterns were determined by 2D echocardiography. Statistical analyses involved bivariate tests (Mann-Whitney, chi2, Spearman's correlation coefficients, ANOVA and receiver-operating-characteristic (ROC) curve analyses) and multivariate tests (multiple linear and logistic regressions). QT dispersion measurements showed significant correlations with echocardiographic LVM (r=0.26-0.27). ROC curves demonstrated a poor isolated predictive performance of all QT parameters for detection of LVH (areas under curve: 0.58-0.59), comparable to that of electrocardiographic voltage criteria. Only patients with concentric hypertrophy had significantly increased QT dispersion (QTd) when compared to those with normal geometries (64.24+/-21.09 vs 53.20+/-15.35, P<0.05). In multivariate analyses, both electrocardiographic and echocardiographic LVH were independent predictors of increased QTd, as well as only QTd and gender were determinants of LVM. In conclusion, increased QT interval dispersion is associated with LVM and concentric hypertrophy geometric pattern in diabetic hypertensive patients, although in isolation neither QTd nor any QT parameter presents enough predictive performance to be recommended as screening procedures for detection of LVH.     

V_1、V_2、V_3的S波及Ⅰ、Ⅱ、aVL的R波之和在诊断左室肥大中的价值

目的探讨诊断左室肥大(LVH)新的心电图指标。方法以超声心动图测定的左室重量(LVM)及重量指数(LVMI)为对照,其诊断LVH的标准为>125g/m2(男),120g/m2(女),对100例正常健康人及111例患者进行了观察,对12导联QRS总振幅(∑QRS)、V1～V3导联的S波之和(∑SV1～V3)、Ⅰ、Ⅱ、aVL导联的R波之和(∑RⅠ、Ⅱ、aVL)及后两者之和(Z表示),分别进行了测定。寻找新指标的正常值范围以及以此标准为依据,诊断LVH的灵敏度、特异度、准确率。结果正常组中,∑QRS、∑SV1～V3、∑RⅠ、Ⅱ、aVL及Z值正常范围分别为77～175,11～38,5～23及22～54mm,以大于这些指标的正常值上限为标准,其诊断LVH灵敏度、特异度及准确率较传统指标明显提高,其中Z值>54mm灵敏度最高(86.54%),准确率最高(90.09%),而特异度仍保持在93.22%。结论LVH新的心电图指标具有一定诊断价值,其中Z>54mm最好。     

Arterial hypertension,left ventricular geometry and QT dispersion in a middle-aged Estonian female population

The aim of the present study was to determine the prevalence of Left ventricular hypertrophy (LVH) and different left ventricular (LV) geometric patterns in the middle-aged women population of Tallinn, to assess the relationship between LV geometry, age, blood pressure and LV repolarization duration and inhomogeneity. A random sample of the population, 482 women aged 35-59, was examined in the framework of a cardiovascular risk factors survey for the WHO/CINDI programme years 1999-2000. Patients with valvular pathology, primary cardiomyopathy, atrial fibrillation, bundle branch blocks and flat T wave on electrocardiography (ECG) were excluded; 398 (82.2%) of the participants underwent echocardiography (Echo) and standard 12-lead ECG at rest and were included in the study. LVH was defined if left ventricular mass (LVM), LVM/height and LVM/BSA were >198 g, >121 g/m and > 120 g/m2, respectively. Arterial hypertension was determined in 23.1% of the women. The prevalence of arterial hypertension was three times higher in those aged 50-59 than in those aged 40-49 (37.4% vs 13.2%; p < 0.05). Different geometric patterns were found as follows: concentric hypertrophy in 9.1%; eccentric hypertrophy 33.9%; concentric remodelling 9.5% and normal geometry 47.5% of the participants. Concentric hypertrophy was found exclusively in hypertensive women and increased with age. No age-related eccentric hypertrophy and concentric remodelling differences were found, either in the normotensive or in the hypertensive group. Prolonged QT dispersion--a marker of increased myocardial electrical instability, was associated with LVH and arterial hypertension and was related mostly to concentric hypertrophy in hypertensives.     

Sex Differences in the Relationships Between Electrocardiographic Abnormalities and the Extent of Left Ventricular Hypertrophy by Echocardiography

Background: Several criteria have been proposed for the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). However, their diagnostic accuracy is questionable. Furthermore, the diagnostic accuracy of abnormalities in ST‐T patterns for LVH is known to be uncertain, especially in women. We examined the relationship between electrocardiographic abnormalities and the extent of LVH. Methods: We studied 76 men and 48 women who satisfied electrocardiographic voltage criteria for LVH (RV₅ or RV₆≥ 2.6 mV, SV₁+ RV₅ or SV₁+ RV₆≥ 3.5 mV) . They were classified into three groups based on ST‐T pattern: normal, early strain, and strain. We defined echocardiographic evidence of LVH as an LV wall thickness ≥ 12 mm. Results: LVH was identified by echocardiography in 55.3% of men and in 47.9% of women. In strain and early strain groups, the prevalence of echocardiographic LVH was significantly higher in men than in women (strain group: 100 vs 75%, P < 0.05, early strain group: 81.8 vs 42.1%, P < 0.05), it did not differ significantly between men and women in normal group. In men, QRS voltage values were significantly correlated with echocardiographic indices. In group strain of men, significant good correlations were observed between QRS voltage values and echocardiographic indices. However, in women, there were no significant correlation between QRS voltage values and echocardiographic indices even in strain group. Conclusions: The combined criteria of both QRS voltage and ST‐T classification could provide a greater accuracy in diagnosing LVH compared to the criteria using QRS voltage alone in men rather than in women.     

Exercise performance in essential hypertension with special reference to blood pressure response and left ventricular hypertrophy.

Exercise performance in essential hypertension (EH) and its relations to blood pressure (BP) response and left ventricular hypertrophy (LVH) were studied. Twenty-three patients with mild to moderate EH and 12 controls underwent symptom-limited (except BP elevation more than 250 mm Hg) ergometer exercise. Exercise performance was evaluated by the oxygen uptake (VO2/kg) at anaerobic threshold (AT) and at peak exercise (Peak). Left ventricular geometry and function, and left ventricular mass index (LVMI) were measured using echocardiography. The endpoints of 12 patients (group A) and controls were fatigue. The endpoints of 11 patients (group B) were BP elevation. Though both group A and group B had concentric hypertrophy, group B showed severe LVH compared to group A and controls. The VO2/kg at AT or at Peak was not different among the three groups. Neither BP response or LVMI correlated with exercise performance in EH. We conclude that exercise performance is not disturbed in EH; that BP response to exercise is not related to exercise performance in EH; and that concentric LVH may be a compensatory mechanism to maintain exercise capacity against exaggerated BP elevation in EH.