高血压左室肥厚伴左心衰竭心脏彩超分析

目的对高血压左室肥厚伴左心衰竭患者的心脏彩超特征进行分析,为今后的临床诊断与治疗工作提供参考。方法抽取2011年11月—2013年11月收治的临床确诊高血压左室肥厚伴左心衰竭患者76例作为高血压组,同期心功能正常者60例作为正常组,对以上统计的两组研究对象展开心脏彩超检查,并对这两组研究对象的检查结果进行对比分析。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果高血压组患者的LAD、LVDd、E/Ea[(50.43±10.17)、(77.74±10.98)mm、14.43±3.71、(55.48±8.97)%]均较心功能正常组[(36.44±8.79)、(45.76±8.76)mm、7.06±2.01]显著升高(均P0.05),而LVEF值[(55.48±8.97)%]则较心功能正常组[(66.75±9.08)%]显著降低(P0.05)。随着心功能分级不断升高,患者的LAD、LVDd、E、Ea水平逐渐升高(P0.05),LVEF水平逐渐降低(P0.05)。结论经心脏彩超可对高血压左室肥厚伴左心衰竭进行准确的诊断,具有可行性,值得关注。     

老年高血压患者胰岛素抵抗与左心室结构左心功能的关系

目的探讨老年高血压患者胰岛素抵抗对左心室结构和左心功能的影响。方法96例老年男性高血压患者,分为老年高血压组(EH)和老年高血压合并左心室肥厚(EH+LVH)组,与90例老年正常血压者比较,检测葡萄糖和胰岛素曲线下面积,胰岛素敏感指数,同时观测左心室结构,左心收缩和舒张功能。总外周血管阻力,并作相关性分析。结果与EH组及正常血压组比较,EH+LVH组的左心室重量指数升高,左心室舒张功能下降,胰岛素敏感指数下降,有显著差异(P<0.05)。血清胰岛素水平与左心室舒张功能显著负相关,胰岛素敏感指数与左心室重量指数,左心室后壁厚度和总心室壁厚度显著负相关。(P<0.05-0.001)。结论老年高血压患者的胰岛素抵抗可促进心肌肥厚发生,并使心室舒张功能下降,应重视胰岛素抵抗的治疗。     

小剂量氢氯噻嗪对大鼠压力超负荷心肌肥厚的干预作用

目的本实验观察小剂量氢氯噻嗪对大鼠压力超负荷心肌肥厚的干预作用,为心肌肥厚的预防和治疗提供临床用药依据。方法采用腹主动脉结扎法制备压力超负荷型心肌肥厚大鼠模型,造模后第二天开始给药,氢氯噻嗪剂量分别为5mg/kg.d、10mg/kg.d,持续30天。以左室重量指数、心肌纤维直径等作为心肌肥厚的指标,观察药物的作用。结果结扎腹主动30天后,模型组与假手术组动物相比,心脏重量指数、心肌纤维直径显著增加(P<0.01)。氢氯噻嗪5mg/kg.d组、10mg/kg.d组的心脏重量指数明显低于模型组(P<0.01),且两组的心肌纤维直径均低于模型组(P<0.05)。结论小剂量氢氯噻嗪对大鼠压力超负荷心肌肥厚的具有干预作用。     

复方制剂缬沙坦——氨氯地平治疗原发性高血压meta分析

  目的  探讨心超技术评价比索洛尔治疗方案对中年高血压患者并发左心室肥厚的降压疗效,并分析其对左心室肥厚的作用。  方法  以分层随机抽样抽取高血压并发左心室肥厚患者的病例,根据患者用药情况分为甲组（比索洛尔 ± 氨氯地平）和乙组（氯沙坦 ± 氨氯地平）,甲组获得病例483例,乙组获得病例506例,比较治疗前后患者血压、左心室质量指数（LVMI）、左心室射血分数（LVEF）、左心室舒张早期峰值流速/左心室舒张晚期峰值流速（E/A）、二尖瓣环舒张早期运动速度/二尖瓣环舒张晚期运动速度（Em/Am）的变化,并比较甲组和乙组上述指标的差异。  结果  甲组患者收缩压由（162.6 ± 15.7）mmHg（1 mmHg = 0.133 KPa）降至（134.8 ± 13.4）mmHg,舒张压由（95.8 ± 14.6）mmHg降至（85.7 ± 8.2）mmHg,差异均具有统计学意义（均P < 0.001）;乙组患者收缩压由（165.5 ± 18.9）mmHg降至（136.7 ± 16.2）mmHg,舒张压由（97.4 ± 17.3）mmHg降至（83.5 ± 8.7）mmHg,差异均具有统计学意义（均P < 0.001）;但甲组与乙组间血压差值治疗前、后均无统计学意义。甲组患者E/A值由（0.70 ± 0.19）升高至（0.87 ± 0.15）,Em/Am值由（0.59 ± 0.14）升高至（0.77 ± 0.16）;乙组患者E/A值由（0.73 ± 0.18）升高至（0.86 ± 0.14）,Em/Am值由（0.63 ± 0.15）升高至（0.79 ± 0.13）;差异均具有统计学意义;但甲组与乙组间E/A、Em/Am差别治疗前、后均无统计学意义。两组患者LVEF均呈上升趋势、LVMI均呈下降趋势,但差异均无统计学意义。  结论  比索洛尔在治疗中年高血压患者左心室肥厚方面的作用与氯沙坦差异无统计学意义,可以作为此类患者治疗的备选方案。     

Angiotensin II receptor blockers and cardiovascular protection: focus on left ventricular hypertrophy regression and atrial fibrillation prevention

Left ventricular hypertrophy (LVH) and atrial fibrillation (AF) are strong predictors of cardiovascular (CV) morbidity and mortality, independently of blood pressure levels and other modifiable and nonmodifiable risk factors. The actions of circulating and tissue angiotensin II, mediated by AT1 receptors, play an important role in the development of a wide spectrum of cardiovascular alterations, including LVH, atrial enlargement and AF. Growing experimental and clinical evidence suggests that antihypertensive drugs may exert different effects on LVH regression and new onset AF in the setting of arterial hypertension. Since a number of large and adequately designed studies have found angiotensin II receptor blockers (ARBs) to be more effective in reducing LVH than beta-blockers and data are also available showing their effectiveness in preventing new or recurrent AF, it is reasonable to consider this class of drugs among first line therapies in patients with hypertension and LVH (a very high risk phenotype predisposing to AF) and as adjunctive therapy to antiarrhythmic agents in patients undergoing pharmacological or electrical cardioversion of AF.     

Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy

Background

Ambulatory blood pressure (BP) is more sensitive than office BP and is highly correlated with the left ventricular mass (LVM) of hypertensive patients with left ventricular hypertrophy (LVH).

Methods

In this prospectively designed ancillary study of the PICXEL trial, the effects of first-line combination perindopril/indapamide on ambulatory BP were compared with those of monotherapy with enalapril in 127 patients. Hypertensive patients with LVH received once daily either perindopril 2 mg/indapamide 0.625 mg (n = 65) or enalapril 10 mg (n = 62) for 52 weeks. Dose adjustments were allowed for uncontrolled BP. Twenty-four-hour ambulatory BP and echocardiographic parameters were measured at baseline, week 24, and week 52.

Results

At study end, both treatments significantly improved ambulatory BP compared with baseline (p ≤ 0.01). Perindopril/indapamide treatment reduced 24-hour and daytime systolic BP (SBP) and pulse pressure (PP) significantly more than enalapril treatment (p < 0.01). No significant between-group differences were noted for diastolic BP (DBP) or for night-time measurements. Trough/peak ratios were higher with perindopril/indapamide than with enalapril (88.5 vs 65.8 for SBP and 86.7 vs 63.9 for DBP, respectively). The global smoothness index was higher with perindopril/indapamide than with enalapril (6.6 vs 5.2 for SBP and 5.6 vs 4.9 for DBP, respectively). With perindopril/indapamide treatment, LVM index was significantly reduced (−9.1 g/m² from baseline; p vs baseline <0.001). More patients required dose increases with enalapril (87%) than with perindopril/indapamide (71%). No unusual safety elements were noted.

Conclusions

First-line perindopril/indapamide combination decreased ambulatory SBP and PP, and LVM more effectively than enalapril.     

儿童青少年原发性高血压左心室结构和功能的研究

目的 探讨儿童青少年原发性高血压左心室结构及心功能的特点, 为有效防治提供参考依据。方法 以超声心动图测量37名原发性高血压患儿心脏结构和功能各项指标, 并与42例健康儿童为对照组作比较分析。结果 原发性高血压组患儿左心室舒张末期内径、左心室收缩末期内径、左心室后壁舒张末期厚度、室间隔舒张末期厚度、左心室质量、左心室质量指数较较对照组显著增高(P＜0.05), 左心室射血分数、左心室短轴缩短率较对照组降低(P＜0.05)。舒张早期峰值血流速度(E峰)较对照组下降(P＞0.05), 舒张晚期峰值血流速度(A峰)上升(P＜0.05), E/A显著下降(P＜0.05)。9例患儿存在左心室肥厚, 1例出现向心性重构。结论 在儿童原发性高血压病中, 心脏作为病变受累的靶器官, 已存在结构和功能的异常改变。     

单纯性肥胖儿童心电图QT离散度与左心室射血分数的关系研究

【目的】　分析单纯性肥胖儿童是否存在心电图QT离散度 (QTD ,QTcD)的改变及其可能的临床应用价值。　【方法】　测量单纯性肥胖组和对照组儿童 12导联心电图RR间期、QT间期并计算QTc、QTD、QTcD ,彩色多普勒测量受试者左室射血分数 (LEF)。　【结果】　肥胖组RR、LEF明显低于对照组 (P <0 .0 1,P <0 .0 0 1) ,QTcD明显高于对照组 (P <0 .0 5 ) ,QTD虽然比对照组大 ,但无统计学意义 (P >0 .0 5 ) ;肥胖组QTD、QTcD与LEF成负相关关系 (r = 0 .485 ,P <0 .0 5 ;r = 0 .5 12 ,P <0 .0 5 ) ,与RR成正相关关系 (r =0 .5 2 0 ,P <0 .0 2 ;r =0 .613 ,P <0 .0 0 5 )。　【结论】　肥胖儿童LEF降低 ,心率增快 ,QTcD显著延长 ;QTD、QTcD的变化可能是肥胖儿童心室肥厚、心肌脂肪浸润等某一或某几项病理改变及心率变化的综合反映 ,也是LEF变化的反映     

转化生长因子β1与原发性高血压左室重构的关系

目的探讨转化生长因子β1(TGF-β1)、血管紧张素II(AII)、醛固酮(ALD)及白介素1α(IL-1α)与原发性高血压(EH)左室重构的关系.方法选择EH患者50例[左室肥厚(LVH)28例,非LVH(NLVH)22例]同步检测血中TGF-β1、AII、ALD及IL-1α水平;用超声心动图仪测定并计算左室质量指数(LVMI).与对照组25例进行对比分析.结果 EH组血中TGF-β1、AII、ALD及IL-1α水平均较对照组显著增高(P<0.001),以LVH为甚.结论 TGF-β1、AII、ALD及IL-1α共同对EH患者的LVH造成影响.     

A diagnosis of left ventricular hypertrophy on ECG is associated with a high cardiovascular risk: findings from a 40- to 69-year-old cohort in general practice

OBJECTIVE: Left ventricular hypertrophy (LVH) is an independent cardiovascular (CV) risk factor in both sexes. We studied if a diagnosis of LVH on electrocardiogram (ECG) was associated with a 'high CV risk condition' among 40- to 69-year-old individuals cared for by GPs. METHODS: We studied 4250 individuals, 5.4% of whom had LVH. Cross-sectional frequencies, and age- and gender-adjusted statistical differences have been calculated. RESULTS: All the study variables were significantly worse for 'LVH' than 'non-LVH' individuals (except smoking). The 'LVH' had both a mean '5-year CV risk' significantly greater than 'non-LVH' individuals (27.0% versus 8.6%), and a significantly higher prevalence of a '5-year CV risk >15%' (89% versus 15%). CONCLUSIONS: A diagnosis of LVH on ECG among the adult individuals of an opportunistic cohort from general practice was associated with a 6-fold greater prevalence of a 'high CV risk condition'.     

上海市社区高血压人群左室肥厚的患病率及影响因素

目的：了解社区人群左室肥厚的患病率及其影响因素，方法：对上海市南市区高血压人群进行横断面调查。结果：调查高血压人群1686人，其中男性978人，女性708人，左室肥厚患病率为29．2％，男女性分别为25．4％和34．5％，女性明显高于男性（X^2＝16．17，P＜0．01），且患病主在两性均随年龄而增加，在45－、55－、65－岁年龄段男女性别之间左室肥厚的患病率差异均有显著性（P＜0．05）。单因素及多因素分析结果表明性别、年龄，文化程度，体重指数，收缩压均是左室肥厚度的影响因素，其中文化程度为保护性因素。结论：社区中老年人左室肥厚度的患病率高，与多种复杂因素有关。应从多方面对这些因素进行针对性防治。     

高血压病患者动态脉压与左心室肥厚的相关性研究

目的 探讨高血压病患者动态脉压和主动脉根部内径（AOD）与左心室肥厚（LVH）之间的相互关系。方法 对240例高血压病患者分别进行24h动态血压监测和超声心动图检查。根据左心室心肌质量指数（LVMI），男〉120g／m^2、女〉110g／m^2作为左心室肥厚的标准，分为左心室肥厚组（94例）和无左心室肥厚组（146例）。结果 24h平均脉压、白昼平均脉压、夜间平均脉压和AOD在高血压左心室肥厚组和无左心室肥厚之间差异均有统计学意义（P〈0．05）。经多元回归分析结果显示：夜间平均脉压和AOD与LVMI的关系最密切（P〈0．001）。结论 AOD和脉压、尤其是夜间平均脉压增大在LVH中起主要决定因素。     

高血压病患者动态脉压与左心室肥厚的相关性研究

目的探讨高血压病患者动态脉压和主动脉根部内径(AOD)与左心室肥厚(LVH)之间的相互关系。方法对240例高血压病患者分别进行24 h动态血压监测和超声心动图检查。根据左心室心肌质量指数(LVMI),男>120 g/m2、女>110 g/m2作为左心室肥厚的标准,分为左心室肥厚组(94例)和无左心室肥厚组(146例)。结果24 h平均脉压、白昼平均脉压、夜间平均脉压和AOD在高血压左心室肥厚组和无左心室肥厚之间差异均有统计学意义(P<0.05)。经多元回归分析结果显示:夜间平均脉压和AOD与LVMI的关系最密切(P<0.001)。结论AOD和脉压、尤其是夜间平均脉压增大在LVH中起主要决定因素。     

代谢综合征及其组分聚集对左心室结构和功能的影响

目的 探讨代谢综合征(MS)患者左心室结构和功能的变化以及MS组分的聚集对左心室结构和功能的影响.方法 检测并比较27例MS患者(MS组)和69例非MS患者(非MS组)的左心室结构和功能,进一步根据MS定义中代谢异常组分的累加评分(0～4分)将所有患者分为5组.比较各组间左心室结构和功能变化.结果 MS组较非MS组舒张末期室间隔厚度(IVSD)、舒张末期左心室后壁厚度(LVPWD)、左心室质量指数(LVMI)均明显增加[(10.22±1.60)mm比(9.31±1.16)mm,(8.95±1.60)mm比(8.23±1.04)mm,(88.23±22.00)g/m~2比(77.56±14.12)g/m~2,P<0.05],等容舒张时间(IVRT)明显延长(P<0.05),二尖瓣口舒张早期血流充盈速度(E)和舒张晚期血流充盈速度(A)比值(E/A)明显降低(P<0.05);而左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)均在正常范围内,且两组间比较差异无统计学意义.随着代谢异常组分分值的增加,IVSD、LVPWD、LVMI均有明显增加,IVRT有明显延长,E/A有明显下降.结论 MS患者较非MS患者有明显的左心室结构改变和左心室舒张功能的减退,且随着代谢异常组分的聚集,左心室结构变化和舒张功能的损害也有所增加.     

Valsartan in the treatment of heart failure or left ventricular dysfunction after myocardial infarction

The physiological role of the renin angiotensin aldosterone system (RAAS) is to maintain the integrity of the cardiovascular system. The effect of angiotensin II is mediated via the angiotensin type I receptor (AT1 ) resulting in vasoconstriction, sodium retention and myocyte growth changes. This causes myocardial remodeling which eventually leads to left ventricular hypertrophy, dilation and dysfunction. Inhibition of the RAAS with angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction has been shown to reduce cardiovascular morbidity and mortality. Angiotensin receptor blockers (ARBs) specifically inhibit the AT1 receptor. It has not been known until the performance of the VALIANT (valsartan in acute myocardial infarction trial) whether blockade of the angiotensin receptor with an ARB or combination of an ACE inhibitor and ARB leads to similar outcomes as an ACE inhibitor. The VALIANT trial demonstrated equal efficacy and non-inferiority of the ARB valsartan 160 mg bid compared with captopril 50 mg tds, when administered to high risk patients with left ventricular dysfunction or heart failure in the immediate post myocardial infarction period. The combination therapy showed no incremental benefit over ACE inhibition or an ARB alone and resulted in increased adverse effects. This review examines the role of valsartan in left ventricular dysfunction post myocardial infarction. We also discuss pharmacokinetics, dosing, side effects, and usage in the elderly.     

Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora Manawa/Community Heart Study

Objectives: Cardiovascular disease (CVD) is the leading cause of mortality in New Zealand with a disproportionate burden of disease in the Māori population. The Hauora Manawa Project investigated the prevalence of cardiovascular risk factors and CVD in randomly selected Māori and non‐Māori participants. This paper reports the prevalence of structural changes in the heart. Methods: A total of 252 rural Māori, 243 urban Māori; and 256 urban non‐Māori underwent echocardiography to assess cardiac structure and function. Multivariable logistic regression was used to determine variables associated with heart size. Results: Left ventricular (LV) mass measurements were largest in the rural Māori cohort (183.5,sd 61.4), intermediate in the urban Māori cohort (169.7,sd 57.1) and smallest in the non‐Māori cohort (152.6,sd 46.7; p<0.001). Similar patterns were observed for other measurements and indexation had no impact. One‐third (32.3%) met the gender‐based ASE criteria for LV hypertrophy (LVH) with higher prevalence in both Maori cohorts (highest in the rural cohort). There were three significant predictors of LVH: rural Māori (p=0.0001); age (p<0.0001); and gender (p=0.0048). Conclusion: Structural and functional heart abnormalities are more prevalent in Māori compared to non‐Māori, and especially rural Māori. Early identification should lead to better management, ultimately improving life expectancy and quality of life.     

ENPP1基因多态位点与左心室肥厚的关系研究

Objective To examine the association between genetic polymorphism of rs1409181 in ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) and left ventricular hypertrophy (LVH) among older Chinese in Guangzhou. Methods 390 subjects aged ≥50 years were randomly selected from the Guangzhou Biobank Cohort Study-CVD. Information on personal history, blood pressure, fasting plasma glucose and lipids were collected. Color Doppler ultrasound was used to measure the indicators of LVH, including left ventricular internal diastolic diameter (LVIDD) , thickness of the interventricular septum diastolic wall (IVSD) and the posterior wall diastolic diameter (LVPWD). LVIDD was calculated using Devereux ventricular mass (LVM)equation while the Left ventricular mass index (LVMI) equation was used to estimate LVH. The genotype of rs1409181 was determined by Taqman SNP genotyping kits using the ABI 7900HT real time PCR system. Results In the GG, CG and CC genotype groups, the proportions of LVH were 21.5%, 28.2% and 37.5% respectively. Compared with GG, the adjusted odds ratios (95% confidence interval) for the LVH were 1.39(0.78-2.50) and 2.36(1.21-4.60) for CG genotype and CC genotype of ENPP1 respectively (P for trend=0.01). Conclusion Polymorphism of ENPP1 gene rs1409181 was associated with LVH in the older Chinese people in Guangzhou.     

ENPP1基因多态位点与左心室肥厚的关系研究

Objective To examine the association between genetic polymorphism of rs1409181 in ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) and left ventricular hypertrophy (LVH) among older Chinese in Guangzhou. Methods 390 subjects aged ≥50 years were randomly selected from the Guangzhou Biobank Cohort Study-CVD. Information on personal history, blood pressure, fasting plasma glucose and lipids were collected. Color Doppler ultrasound was used to measure the indicators of LVH, including left ventricular internal diastolic diameter (LVIDD) , thickness of the interventricular septum diastolic wall (IVSD) and the posterior wall diastolic diameter (LVPWD). LVIDD was calculated using Devereux ventricular mass (LVM)equation while the Left ventricular mass index (LVMI) equation was used to estimate LVH. The genotype of rs1409181 was determined by Taqman SNP genotyping kits using the ABI 7900HT real time PCR system. Results In the GG, CG and CC genotype groups, the proportions of LVH were 21.5%, 28.2% and 37.5% respectively. Compared with GG, the adjusted odds ratios (95% confidence interval) for the LVH were 1.39(0.78-2.50) and 2.36(1.21-4.60) for CG genotype and CC genotype of ENPP1 respectively (P for trend=0.01). Conclusion Polymorphism of ENPP1 gene rs1409181 was associated with LVH in the older Chinese people in Guangzhou.