Changes of Dopamine and Atrial Natriuretic Factor by Mild Exercise for Hypertensives

Changes of humoral factors related to the regulation of fluid volume were investigated in exercise training for hypertensives. Twelve patients with essential hypertension were treated with an aerobic exercise for 10 weeks. A significant reduction in blood pressure from 161±3/100±2 mmHg at week 0 to 142±5/94±3 mmHg at week 4 was observed which continued until week 10. Urine dopamine was increased significantly at the 4th week from 386±29.4 μg/day at week 0 to 524±46.3 μg/day and plasma atrial natriuretic factor (ANF) was significantly reduced at the 4th week, from 41.5±2.7 pg/ml at week 0 to 32.6±3.7 pg/ml. Plasma volume was found reduced significantly from 2,531±166 ml/m² at week 0 to 2,221±165 ml/m² at week 10. These results suggest that the increase of dopamine and reduction of plasma ANF which took place at the early stage might be related to, at least in part, the depletion of plasma volume and the reduction of blood pressure in mild exercise for hypertensives.     

早期原发性高血压左心室舒张功能的超声心动图评价

目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。     

Left Atrial Structure and Function,and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review

Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.     

Study on Left Ventricular Diastolic Function under Different Left Ventricular Systolic Function

Ithasbecomeincreasinglyclearthatabnormali－tiesofdiastolicfunctionhaveamajorroleinproducingsignsandsymptomsinpatientspresentingwithhearfailure犤１，２犦．Asmanyasone－thirdofpatientswiththediagnosisofheartfailurehavenormalsystolicfunction，whichimplicates     

高血压右室与左室舒张功能的关系

对64例Ⅰ、Ⅱ期临床无心功能不全表现的高血压患者，32例年龄与性别相匹配的健康者，应用多普勒超声心动图技术，对其右室舒张功能进行测定，同时测定其左室收缩及舒张功能并作比较，高血压组按超声心动图标准分为左室肥厚组（LVH）34例，无左室肥厚组（NLVH）30例。测定结果表明,NLVH组与正常组比较，前者通过三尖瓣的E峰较低（P＜0.05），A峰较高（P＜0.05），E／A比值较小（P＜O.01)，快速充盈分数(PFF），l／3充盈数(1／3EF）和校正的充盈率峰值（PFR）也降低（P＜0.05），下降时间（DT）延长（P＜0.01）。LVH组中上述各参数与正常组比较也均有降低，与NLVH组比较A峰、E／A比值和PFR有进一步损害。相关分析发现，右室充盈参数与左室充盈参数密切相关（r从0.45到0.80）。     

红细胞变形性在原发性高血压中的变化及对左心室舒张功能的影响

目的观察红细胞变形性对原发性高血压及左心室舒张功能的影响。方法对原发性高血压患者进行红细胞滤过指数（ＩＦ），血压（ＥＳＲ），Ｋ值，红细胞电泳（ＥＥＰ），红细胞膜钙内流（ＥＣＣ），红细胞钙泵活性（ＥＣＰ）和左心室舒张功能（Ｅ／Ａ）检测。结果原发性高血压患者比对照组，ＩＦ、ＥＳＲ、ＥＥＰ，Ｋ值，ＥＣＣ明显增加，而ＥＣＰ和ＶＥ／ＶＡ明显减少。ＩＦ与Ｅ／Ａ（Ⅱ期高血压）呈负相关。结论在原发性高血压中红细胞变形能力下降并与左心室舒张功能有相关。     

Left Ventricular Diastolic Function in the Elderly

Previous studies using pulsed Doppler echocardiography have demonstrated a pattern of abnormal left ventricular relaxation associated with increasing age. Specifically, aging is associated with decreased peak velocity of early diastolic mitral inflow, increased peak velocity of late diastolic inflow, increased isovolumic relaxation time, and early diastolic deceleration time. Abnormal relaxation can progress to significantly elevated left atrial pressure—characterized by increased early peak velocity and shortened isovolumic relaxation time and deceleration time—as part of the disease processes. Left ventricular diastolic dysfunction is highly prevalent, occurring in one half to two thirds of elderly patients with congestive heart failure, in association with normal systolic function. Left ventricular hypertrophy, which is commonly related to systemic arterial hypertension, and ischemic heart disease are the two major causes of abnormal left ventricular diastolic function in the elderly. Recently, newer echocardiographic techniques have been described that allow more accurate evaluation of left ventricular diastolic function. Treatments for left ventricular diastolic dysfunction should focus on the underlying disease etiology as well as on the derangement in left ventricular diastolic function. Although calcium channel blockers and angiotensin—converting enzyme inhibitors have been used clinically to treat diastolic dysfunction, their effects on prognosis remain unproven.     

心内科住院患者脉搏波传导速度与左心室舒张功能的相关性

目的 评价心内科住院患者肱踝脉搏波传导速度（baPWV）与左心室舒张功能的关系。方法 选择652例于2012年11月至2013年10月因心血管疾病在北京大学第一医院心内科住院患者,收集一般住院资料,测定baPWV,行心脏彩超等检查。以左心室舒张功能不同分为舒张功能正常组（E/A≥0.8,E/E′≤8）、轻度舒张功能不全组（E/A＜0.8,E/E′≤8）、中度舒张功能不全组（0.8≤E/A≤1.5,8＜E/E′＜13）、重度舒张功能不全组（E/A≥2.0,E/E′≥13）,比较四组间baPWV水平。采用Spearman相关分析判定baPWV与左心室舒张功能的相关性。以重度左心室舒张功能不全（E/E′≥13）作为终点事件,应用多因素Logistic回归模型校正影响左心室舒张功能不全的混杂因素。结果 四组间baPWV随左心室舒张功能减退而升高（P<0.001）。研究对象中baPWV与E/A比值呈明显负相关（r＝-0.257,P<0.001）,baPWV与E/E′比值呈明显正相关（r＝0.249,P<0.001）。多因素Logistic回归分析显示,baPWV≥1400 cm/s是左心室舒张功能不全的危险因素,其RR值为1.93（95%CI为1.09～3.44,P＝0.03）。结论 baPWV与左心室舒张功能具有相关性,可以作为左心室舒张功能减退的高危人群的筛查方法。     

应用超声心动图评价轻中度高血压左房及左室功能

应用超声心动图自动边缘技术（ＡＢＤ）实时评价２１例正常人及３１例轻中度高血压病人左心收缩及舒张功能。研究结果表明：高血压组病人左室舒张功能受损早于收缩功能受损；左房收缩功能（左房做功）及舒张功能（左房贮存）均增加（Ａｆｓ　４９．１±６．４％ＶＳ　３０．１±５．４％；ｐ＜０．０５；ＳＡＥＩ４１．０±５．０％ＶＳ．３６．３±４．３％，ｐ＜０．０５；ＤＡＥＩ７０．１±６．８％ＶＳ７．１±９．４％，ｐ＜０．００１）；左房左室功能相互联系。因此，在评价高血压心脏功能时，须综合考虑。     

高血压左室舒张功能对心房电-机械时间的影响

目的采用组织多普勒成像(TDI)研究原发性高血压患者左室舒张功能对心房电机械时间的影响。方法原发性高血压患者90例,根据左室舒张功能将其分为3组:正常充盈组(NF组,32例)、松弛功能受损组(IR组,28例)、假性正常化/限制性充盈组(PN/R组,30例)。采用TDI分别测量左、右房室瓣瓣环处的心房电机械时间(LPA与RPA)。结果与NF组比较,LPA与RPA值在IR组和PN/R组延长;与IR组比较,PN/R组的LPA与RPA值延长[(分别为74.1±11.6vs83.1±13.7、40.3±10.5vs47.7±10.4)ms,P<0.05]。结论原发性高血压患者的心房电机械时间随左室舒张功能受损加重而延长,在假性正常化/限制性充盈阶段明显延长,该参数可以做为其他超声诊断心室舒张指标的一个补充指标。     

高血压左室舒张功能对心房电-机械时间的影响

目的采用组织多普勒成像(TDI)研究原发性高血压患者左室舒张功能对心房电机械时间的影响.方法原发性高血压患者90例,根据左室舒张功能将其分为3组:正常充盈组(NF组,32例)、松弛功能受损组(IR组,28例)、假性正常化/限制性充盈组(PN/R组,30例).采用 TDI分别测量左、右房室瓣瓣环处的心房电机械时间(LP-A与RP-A).结果与 NF组比较,LP-A与RP-A值在IR组和PN/R组延长;与IR组比较,PN/R组的LP-A与RP-A值延长[(分别为 74.1±11.6 vs 83.1±13.7、40.3±10.5 vs 47.7±10.4)ms,P<0.05].结论原发性高血压患者的心房电机械时间随左室舒张功能受损加重而延长,在假性正常化/限制性充盈阶段明显延长,该参数可以做为其他超声诊断心室舒张指标的一个补充指标.     

Left Ventricular Hypertrophy Determines the Severity of Diastolic Dysfunction in Patients with Nonvalvular Atrial Fibrillation and Preserved Left Ventricular Systolic Function

Regression of left ventricular (LV) hypertrophy (LVH) is known to be related to a lower incidence of stroke in hypertensive patients with nonvalvular atrial fibrillation (NV-AF). However, its mechanism remains controversial. Recently, diastolic dysfunction (DD) was reported to be correlated with ischemic stroke in NV-AF. We hypothesized that hypertension (HTN) and resultant LVH might be associated with the severity of DD in NV-AF. Two hundred and ninety-four patients (204 males, age 66 ± 12 y) with NV-AF with preserved LV systolic function were included. Clinical and echocardiographic data were compared between patients with enlarged left atrial (LA) volume (n == 237) and patients with normal LA. Age (60 ± 12 vs. 67 ± 11 years), sex (male; 81 vs. 62%%), duration of NV-AF (4.1 ± 7.8 vs. 45.7 ± 49.0 months), brain natriuretic peptide (108.3 ± 129.3 vs. 236.1 ± 197.0 pg//mL), right ventricular systolic pressure (24.5 ± 5.5 vs. 33.1 ± 11.1 mmHg), mitral inflow velocity (E [77.4 ± 22.2 vs. 88.3 ± 22.0 cm//s]), LV mass index (LVMI [87.6 ± 22.2 vs. 105.1 ± 23.2 g//m²]), peak systolic mitral annular velocity (S' [7.2 ± 2.0 vs. 5.8 ± 1.8 cm//s]), and mitral inflow velocity to diastolic mitral annular velocity (E//E' [9.8 ± 3.4 vs. 12.1 ± 4.4]) were significantly different between the two groups, respectively (P < 0.05). In multivariate analysis, LVMI was independently correlated with increased LA volume (OR: 1.037 [95%% CI: 1.011–1.063], P < 0.05), whereas HTN was not. LA enlargement, which reflects the severity and chronicity of DD, is independently associated with LVH in patients with NV-AF. Therefore, regression of LVH with anti-hypertensive treatment may lead to improvement of diastolic function and favorable clinical outcomes in hypertensive patients with NV-AF.     

Tissue Doppler to Assess Diastolic Left Ventricular Function

Doppler indices of left ventricular (LV) filling have been used traditionally for the assessment of LV diastolic function. In many circumstances, however, the interpretation of these indices is difficult because they respond to alterations of different physiological variables such as preload, relaxation, and heart rate. A typical example of their limitation is seen in patients with abnormal LV relaxation and increased preload compensation, who often present a "pseudonormal" LV filling pattern. Thus, there is a need for noninvasive indices of diastolic function capable of discriminating the effects of relaxation and preload. Tissue Doppler echocardiography (TDE) is available in most modern cardiac ultrasound imaging systems. TDE can be used to obtain regional myocardial velocities during isovolumic relaxation, early filling, and atrial systole with high spatial and temporal resolution. This article discusses the complementary role, limitations, and future challenges of TDE in the study of diastolic function.     

冠心病患者P波离散度和P波最大宽度与左心室舒张功能的相关性

目的　探讨冠心病患者P波离散度（PWD）和P波最大宽度（Pmax）与左心室舒张功能的相关性。方法选取冠心病患者100例,应用12导联同步心电图仪测量PWD和Pmax,依据PWD分为：PWD≥40　ms组,PWD<40　ms组;依据Pmax时限分为：Pmax≥110　ms组,Pmax<110　ms组。比较各组患者冠状动脉狭窄程度、E/A比值、舒张期减速时间（DT）、左房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、阵发性房颤发生率等指标。结果　PWD≥40　ms组及Pmax≥110　ms组的冠状动脉狭窄程度、E/A比值、DT、LAD、LVEDD及阵发性房颤发生率与对照组相比差异有统计学意义（P<0.05）;所有患者的PWD及Pmax与冠状动脉狭窄程度、DT、LAD、LVEDD成正相关,与E/A比值呈负相关（P<0.05）;多元线性回归显示在控制了年龄、房颤、高血压病、生化指标等因素后,上述指标与PWD及Pmax独立相关性仍较显著。结论　P波离散度和P波最大宽度能够在一定程度上反映冠心病患者左心室舒张功能及预测阵发性心房颤动的发生。