长期应用培哚普利与氨氯地平对高血压病患者左心室舒张功能的影响

目的 比较长期服用钙拮抗剂与血管紧张素转化酶抑制剂对高血压患者左心室舒张功能的影响。方法 将78例轻、中度高血压患者随机分成两组,一组服用培哚普利,另一组服用氨氯地平,疗程一年,目标血压＜140／90mmHg。采用超声心动图评估患者治疗前、治疗后3、6、12个月的左心室舒张功能。结果 68例患者完成实验,其左心室舒张功能指标如E峰、A／E比率、E峰下降速率较治疗前显著升高,而A峰相关指标则较治疗前显著降低。结论 培哚普利及氨氯地平可以显著改善高血压患者的左心室舒张功能。     

内源性类洋地黄物质对高血压病患者左室舒张功能的影响

测定 2 0例正常人和 2 0例高血压病患者的心尖搏动图指数、血清内源性类洋地黄物质 （EDL S）浓度、红细胞膜 Na+ - K+ - ATP酶 （钠泵 ）活性及红细胞内钾、钠、钙总量。结果显示 ,与正常人比较 ,高血压病患者的房缩波与E- O垂直高度比值 （A/E- O）明显增高 ,等容舒张期 （IRT）明显延长 ,血清 EDL S浓度明显升高 ,红细胞膜钠泵活性下降 ,红细胞内钠、钙含量升高、钾含量下降 ,且血清 EDL S浓度与 A/E- O,IRT呈显著正相关。提示 EDL S可能参与高血压病患者左室舒张功能异常的形成 ,其机制可能与 EDL S抑制心肌细胞膜钠泵活性并导致细胞内 Ca2 +含量升高有关     

Influence of low high-density lipoprotein cholesterol on left ventricular hypertrophy and diastolic function in essential hypertension

BackgroundLeft ventricular (LV) hypertrophy and LV diastolic dysfunction, which are common cardiac changes in hypertensive patients, are modified by several nonhemodynamic (eg, genetic, neurohumoral, and metabolic) factors. However, the influence of serum lipids on these LV changes has not been sufficiently studied. Although low high-density lipoprotein (HDL) cholesterol is well known to be a major risk factor for coronary heart disease, it is unclear whether HDL cholesterol plays a role in hypertensive heart disease.MethodsIn 274 patients with treated essential hypertension, two-dimensional and Doppler echocardiography were performed, and LV mass, ratio of peak velocity of atrial filling to early diastolic filling (A to E ratio [A/E]), and deceleration time of the E-wave were evaluated. The relationship of dyslipidemia, especially low HDL cholesterol, to LV hypertrophy and diastolic function was investigated in these patients.ResultsIn a univariate regression analysis, HDL cholesterol was inversely associated with LV mass, A/E, and deceleration time. The association of HDL cholesterol with LV diastolic function was observed in both men and women. Its association with LV mass was gender-dependent, being significant only in women. Triglycerides were weakly correlated with LV mass and A/E, but total and low-density lipoprotein cholesterol had no correlations with these indices. In a multiple regression analysis, only low HDL cholesterol among several lipid levels was an independent predictor of both LV mass and LV diastolic dysfunction.ConclusionsOur findings suggest that low HDL cholesterol may unfavorably modify LV structure and diastolic function in patients with treated essential hypertension.     

Influence of plasma aldosterone on left ventricular geometry and diastolic function in treated essential hypertension.

Since aldosterone is known to promote interstitial fibrosis in cardiac tissues, it is possible that aldosterone may influence cardiac structure and function. In the present study, we investigated whether plasma aldosterone concentration (PAC) is related to the distinct patterns of left ventricular (LV) geometry and LV diastolic function in treated essential hypertension. In 92 patients with chronically treated essential hypertension, two-dimensional and Doppler echocardiographic examinations were performed and LV inflow velocities were measured for evaluation of LV diastolic function. When patients were divided into four groups by the different LV geometric patterns, PAC in patients with eccentric hypertrophy was significantly higher than in those with concentric hypertrophy (15.2+/-2.1 vs. 10.0+/-0.7 ng/dl, p<0.01). However, the ratio of the peak velocity of early diastolic filling to that of atrial filling (EIA), an index of LV diastolic function, was significantly decreased in patients with concentric hypertrophy compared with those showing normal geometry. In the relationship between PAC and LV diastolic function, PAC was negatively correlated with EIA (r=-0.35, p<0.05) only in the subgroup with normal relative wall thickness (i.e., without the concentric change in LV geometry). A multiple linear regression analysis showed that PAC was one of the independent determinants of E/A in the overall subject group. These observations indicate that PAC is associated with the eccentric change in LV geometry in patients with treated essential hypertension and also suggest that the increase in PAC participates in the impairment of LV diastolic function apart from the concentric change in LV geometry, although concentric hypertrophy clearly impairs LV diastolic function.     

老年高血压病人左室肥厚与左室舒张功能的关系

目的：研究老年高血压病人左室肥厚与左室舒张功能各参数的关系,探讨在老年人左室肥厚对左室舒张功能的影响。方法：用彩色多普勒超声心动图测量101例老年高血压病人左心室结构及舒张功能参数。结果：101例高血压病人中,左室肥厚组（48例）的左房内径指数（LADI）、等容舒张时间（IVRT）、舒张期二尖瓣E波减速时间（EDT）显著大于左室正常组（53例,P〈0．05～〈0．01）．多元逐步回归分析发现,左室质量指数（LVMI）与左房射血分数（LAEF）、LADI、IVRT和EDT有明显的相关关系（r分别为0．213,0．251．0．450．0．338．P〈0．05～0．001）结论：老年高血压病人的左室增厚可进一步降低左室舒张功能。     

Influence of hypertension on systolic and diastolic left ventricular function including segmental strain and strain rate

Background

Left ventricular (LV) systolic and diastolic functions are important cardiovascular risk predictors in patients with hypertension. However, data on segmental, layer-specific strain, and diastolic strain rates in these patients are limited. The aim of this study was to investigate segmental two-dimensional strain rate imaging (SRI)-derived parameters to characterize LV systolic and diastolic function in hypertensive individuals compared with that in normotensive individuals.

Methods

The study sample comprised 1194 participants from the population-based Know Your Heart study in Arkhangelsk and Novosibirsk, Russia, and 1013 individuals from the Seventh Tromsø Study in Norway. The study population was divided into four subgroups: (A) healthy individuals with normal blood pressure (BP), (B) individuals on antihypertensive medication with normal BP, (C) individuals with systolic BP 140–159 mmHg and/or diastolic BP > 90 mm HG, and (D) individuals with systolic BP ≥160 mmHg. In addition to conventional echocardiographic parameters, global and segmental layer-specific strains and strain rates in early diastole and atrial contraction (SR E, SR A) were extracted. The strain and SR (S/SR) analysis included only segments without strain curve artifacts.

Results

With increasing BP, the systolic and diastolic global and segmental S/SR gradually decreased. SR E, a marker of impaired relaxation, showed the most distinctive differences between the groups. In normotensive controls and the three hypertension groups, all segmental parameters displayed apico-basal gradients, with the lowest S/SR in the basal septal and highest in apical segments. Only SR A did not differ between the segmental groups but increased gradually with increasing BP. End-systolic strain showed incremental epi-towards endocardial gradients, irrespective of the study group.

Conclusion

Arterial hypertension reduces global and segmental systolic and diastolic left ventricular S/SR parameters. Impaired relaxation determined by SR E is the dominant factor of diastolic dysfunction, whereas end-diastolic compliance (by SR A) does not seem to be influenced by different degrees of hypertension. Segmental strain, SR E and SR A provide new insights into the LV cardio mechanics in hypertensive hearts.     

高血压病左房结构及左室舒张功能的超声心动图改变

高血压是最常见的心血管疾病,可引起严重的心、脑、肾并发症,是脑卒中、冠状动脉粥样硬化性心脏病的主要危险因素。研究表明,高血压病患者出现左室舒张功能障碍早于收缩功能障碍。对无症状高血压患者,通过超声心动图检查早期发现其舒张功能改变,及时采取预防措施,对防止高血压病进展具有一定的意义。     

Characteristics of left ventricular diastolic function in patients with hypertension]

Left ventricular (LV) diastolic filling was examined by Doppler echocardiography in 239 patients with essential hypertension and 100 normal subjects. The Doppler study showed an inverse correlation between age and early diastolic peak velocity (PVE, r-0.201, P less than 0.05) [and a positive correlation between age and late diastolic peak velocity (PVA, r = 0.202, P less than 0.05) in normal subjects. Isovolumic relaxation time and late diastolic filling time were prolonged, PVA, A/E and Ai elevated, PVE, E/A and Ei/Ai as well as total filling time decreased in patients with hypertension as compared with the values found in the normal subjects (P less than 0.05 to 0.01). The results showed definite impairement of LV diastolic function in hypertensive patients. PVA correlated positively with systolic blood pressure (r = 0.68, P less than 0.01) and modestly with left atrial dimension in the hypertensives. No significant differences were found in FS and EF between the two study populations, indicating that LV filling abnormalities may occur early in patients with hypertension, even at a time when systolic performance has not yet been affected.     

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3 ± 12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e′ velocity, a′ velocity, and E/e′ ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P = 0.003), interventricular septum (P = 0.001), LV posterior wall thickness (P = 0.001) and E/e′ ratio (P ˂ 0.001), but a decrease in e′ velocity (P = 0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11–1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.     

Pioglitazone improves left ventricular diastolic function in patients with essential hypertension

BACKGROUND: Left ventricular (LV) hypertrophy and diastolic dysfunction, which are common cardiac consequences of hypertension, are modified by insulin resistance. The present study assessed the hypothesis that primary treatment of insulin resistance may reverse such cardiac changes in hypertensive patients. METHODS: A total of 30 patients with essential hypertension were enrolled in this study. In echocardiographic examinations, LV mass index, the peak velocity ratio of early diastolic to atrial filling (E/A), and the E-wave deceleration time (DcT) were determined. Insulin sensitivity test with steady-state plasma glucose (SSPG) method, oral glucose tolerance test, and blood samplings for measurement of adiponectin and matrix metalloproteinase (MMP)-2 were also performed. Six months after treatment with pioglitazone (30 mg/day), an insulin sensitizer, these examinations were repeated. RESULTS: Pioglitazone significantly increased E/A and decreased DcT, without a change in LV mass index. These improvements in diastolic properties were much greater in subjects with a marked (>or==3.3 mmol/L) decrease in SSPG (n=11) than the others (n=19), although the decrease in glucose levels did not differ between the two groups. In addition, the changes in E/A and DcT were closely correlated with the decrease in SSPG. Pioglitazone treatment significantly elevated plasma adiponectin and MMP-2 levels, and the increase in MMP-2 was positively correlated with the increase in adiponectin. CONCLUSIONS: The present findings demonstrate that pioglitazone improves LV diastolic function without LV mass regression in hypertensive patients in proportion to the amelioration of insulin resistance. These findings suggest that increased adiponectin and MMP may be involved in the beneficial effect of pioglitazone on diastolic function.     

白大衣高血压患者血压变异性对靶器官损害的影响

目的探讨血压变异性对白大衣高血压患者靶器官损害的影响。方法门诊患者119例,根据24 h动态血压和诊室血压分为正常血压组(NT)和白大衣高血压组(WCH)。其中白大衣高血压组根据24 h收缩压变异程度分为:白大衣高血压血压变异性低组(WCH-L),白大衣高血压血压变异性高组(WCH-H)。心脏和颈动脉超声检查:计算二尖瓣环心肌舒张早期峰值运动速度(Em)与舒张晚期峰值运动速度(Am)比值(Em/Am),评价左心室舒张功能及颈动脉损害的发生率。结果 (1)NT组左心室舒张功能减退发生率(21.87%,7例/32例)、颈动脉损害的检出率(18.75%,6例/32例)与WCH-L组(31.11%,14例/45例;22.22%,10例/45例)相近,组间差异无统计学意义(P=0.370、0.711);(2)WCH-H组左心室舒张功能减退发生率(52.38%,22例/42例)、颈动脉损害的检出率(42.85%,18例/42例)明显高于NT组(P=0.008、0.028)和WCH-L组(P=0.044、0.040),差异均有统计学意义。结论血压变异性较大的白大衣高血压患者具有较高的靶器官损害发生率。     

瑞舒伐他汀对老年高血压患者左心室舒张功能的影响

目的:评价瑞舒伐他汀对老年高血压患者左心室舒张功能的影响。方法:选取服用降压药的老年高血压患者128例,随机分为治疗组和对照组,治疗组给予口服瑞舒伐他汀6个月,分别测定两组患者治疗前后左心室后壁舒张末期厚度(LVPWT)、室间隔舒张末期厚度(IVST)、舒张早期峰值流速(E)、舒张晚期峰值流速(A)和E/A值,同时测定两组患者治疗前后血压、血脂的变化。结果:与治疗前相比,治疗组与对照组患者的SBP,DBP以及脉压差均明显降低(均P0.05);治疗组患者治疗后血清TC、TG、LDL-C均显著降低(P0.01),同时治疗组患者治疗后LVPWT、IVST、A均显著降低(P0.01);E明显升高(P0.01);E/A值明显升高(P0.05)。而对照组这些指标未见显著差异。结论:老年高血压患者在降压的同时联用瑞舒伐他汀能改善左心室舒张功能。     

The left ventricular diastolic function in patients with hypertension and calcium inhibitors

One of the first detectable signs of hypertensive heart disease is impairment of left ventricular filling. This filling defect depends, although not exclusively, on left ventricular hypertrophy (LVH), load factors and ischemic factors. LVH is an adaptive phenomenon triggered by the dysfunction of various parameters, such as increased in peripheral resistance, reduced arterial elasticity and increased sodium reserve. Calcium channel inhibitors act at several levels to permit regression of the LVH and contribute to improved left ventricular filling conditions.     

原发性高血压患者ST-T向量与左心室舒张功能关系的研究

目的　探讨立体心电图 ST-T向量与左心室舒张功能的关系 ,并与超声心动图对左心室舒张功能 (L VDF)比较评价二者的相关性和敏感性。方法　应用 M型、脉冲多普勒超声心动图对 12 7例原发性高血压患者测定左心房内径 (LAD)、左心室质量指数(LVMI)、EF斜率、射血分数、二尖瓣口血流频谱 A峰 ,E峰 ,A/E比值 ,同时用立体心电图仪对 12 7例原发性高血压患者及 3 0例正常对照组 ST-T向量。结果　原发性高血压左心室肥大 (LVH)组较非左心室肥大 (NL VH)组 A/E比值显著增大。原发性高血压LVH和 NLVH组与对照组比较 ST-T向量各指标均有差异 ;A/E比值与立体心电图 ST-T向量判定 LVDF障碍显著有关联 ,且ST-T向量较 UCG更敏感 ;多元线性回归示 A/E比值与 ST-T向量积分 ,心率 ,年龄 ,危险度分层相关。结论　立体心电图 ST-T向量及其积分与 A/E比值相关良好 ,且可能比后者更为敏感