Lack of Association Between Blood Pressure Variability and Left Ventricular Mass in Essential Hypertension

Blood pressure (BP) variability could induce detrimental effects on left ventricular (LV) structure in hypertension. We investigated the association between short-term BP variability, assessed with 24-h noninvasive ambulatory BP monitoring, and LV mass at echocardiography in 1822 untreated subjects (953 men, 869 women) with essential hypertension (EH). The standard deviation (SD) of daytime and night-time systolic BP (SBP, r = 0.13/0.10; both P < .001), but not of diastolic BP, showed a weak correlation with LV mass. Because the SD of daytime SBP showed a direct association with average 24-h SBP (r = 0.27), subjects were ranked into quartiles of the distribution of 24-h SBP. For each quartile, the subjects with SD of daytime (and night-time) SBP below or above the median were classified at low or high BP variability. In both genders, subjects with high daytime SBP variability were older than those at low variability (both P < .01). Within each quartile, LV mass did not differ between the groups at low v those at high SBP variability. Overall, age-adjusted LV mass index was 115 and 115 g/m² in men at low and high daytime SBP variability (P = .84), and 116 and 114 g/m² in men at low and high nighttime SBP variability (P = .31). The corresponding values in women were 98 and 99 g/m² (P = .53) and 98 and 99 g/m² (P = .64). In conclusion, when the effects of age, gender, and average 24-h BP are taken into account, short-term BP variability assessed with noninvasive monitoring is unrelated to LV mass in subjects with EH.     

Association of Wolff-Parkinson-White With Left Ventricular Noncompaction Cardiomyopathy in Children

BackgroundWolff-Parkinson-White (WPW) has been associated with left ventricular noncompaction (LVNC) in children. Little is known about the prevalence of this association, clinical outcomes, and treatment options.MethodsRetrospective review of subjects with LVNC. LVNC was defined by established criteria; those with congenital heart disease were excluded. Electrocardiograms (ECGs) were reviewed for presence of pre-excitation. Outcomes were compared between those with isolated LVNC and those with WPW and LVNC.ResultsA total of 348 patients with LVNC were identified. Thirty-eight (11%) were found to have WPW pattern on ECG, and 84% of those with WPW and LVNC had cardiac dysfunction. In Kaplan–Meier analysis, there was significantly lower freedom from significant dysfunction (ejection fraction ≤ 40%) among those with WPW and LVNC (P < .001). Further analysis showed a higher risk of developing significant dysfunction in patients with WPW and LVNC versus LVNC alone (hazard ratio 4.64 [2.79, 9.90]). Twelve patients underwent an ablation procedure with an acute success rate of 83%. Four patients with cardiac dysfunction were successfully ablated, 3 having improvement in function.ConclusionWPW is common among children with LVNC and is associated with cardiac dysfunction. Ablation therapy can be safely and effectively performed and may result in improvement in function.     

Visceral Adiposity and Left Ventricular Mass and Function in Patients With Aortic Stenosis: The PROGRESSA Study

Background

Recent studies have reported that obesity, metabolic syndrome, and diabetes are associated with left ventricular (LV) hypertrophy (LVH) and dysfunction in patients with aortic stenosis (AS). The purpose of this study was to examine the association between amount and distribution of body fat and LVH and systolic dysfunction in AS patients.

Methods

One hundred twenty-four patients with AS were prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study and underwent Doppler echocardiography and computed tomography scan. Presence and severity of LVH was assessed according to LV mass indexed for height^2.7 and LV dysfunction according to global longitudinal strain (GLS). Computed tomography was used to quantify abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue, and total adipose tissue (TAT).

Results

Body mass index (BMI) correlated strongly with TAT (r = 0.85), moderately with VAT (r = 0.70), and SAT (r = 0.69), and weakly with the proportion of VAT (VAT/TAT ratio: r = 0.19). In univariate analysis, greater BMI, TAT, VAT, SAT, and VAT/TAT were associated with increased LV mass index and greater VAT and VAT/TAT ratio were associated with reduced GLS. Multivariate analysis revealed that larger BMI (P < 0.0001) and greater VAT/TAT ratio (P = 0.01) were independently associated with higher prevalence of LVH, and only the VAT/TAT ratio (P = 0.03) was independently associated with reduced GLS.

Conclusions

The results of this study suggest that total and visceral adiposity are independently associated with LVH in patients with AS. Furthermore, impairment of LV systolic function does not appear to be influenced by total obesity but is rather related to excess visceral adiposity. These findings provide impetus for elaboration of interventional studies aiming at visceral adiposity in the AS population.     

伴左室肥厚高血压病患者发生室性心律失常临床意义的探讨

对１２９例高血压病患者进行２４小时动态心电图监测，分析室性心律失常的发生。结果表明：伴左室肥厚高血压组（ｎ＝４８）复杂室性心律失常（按Ｌｏｗｎ分级≥ＩＩＩ级）的发生率显著高于无左室肥厚的高血压组（ｎ＝８１），７０．８％ＶＳ１３．６％，Ｐ＜０．００５；复杂室性心律失常昼夜变化以晨６时至正午１２时发生率较高。提示高血压病左室肥厚存在复杂室性心律失常易发性及致心律失常源的基础。积极逆转左室肥厚、改善心肌缺血及抗室性心律失常的治疗是有意义的。     

左室质量比值和左室质量指数对高血压左室重构识别的比较

目的 比较左室质量比值(％PLM)和左室质量指数(LVMI)对左室重构识别的价值。方法 对187例高血压患者进行超声心动图检查，测量其心脏结构和功能。结果 左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1％、48．7％和3．2％。％PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数。左室肥厚(LVH)时，iLVM的左室射血分数、左室短轴缩短率低于aLVM(P＜0．01)。但在aLVM或iLVM中．LVH和无LVH两组间的左室收缩功能无明显差异(P＞0．05)。结论 ％PLM识别左室重构比LVMI更符合生理情况，更能精确地对高血压患者进行危险分层。     

左室质量比值和左室质量指数对高血压左室重构识别的比较

目的比较左室质量比值(%PLM)和左室质量指数(LVMI)对左室重构识别的价值.方法对187例高血压患者进行超声心动图检查,测量其心脏结构和功能.结果左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1%、48.7%和3.2%.%PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数.左室肥厚(LVH)时, iLVM的左室射血分数、左室短轴缩短率低于aLVM(P<0.01).但在aLVM或iLVM中,LVH和无LVH两组间的左室收缩功能无明显差异(P>0.05).结论 %PLM识别左室重构比LVMI更符合生理情况,更能精确地对高血压患者进行危险分层.     

Association of Left Ventricular Longitudinal and Circumferential Systolic Dysfunction With Diastolic Function in Hypertension: A Nonlinear Analysis Focused on the Interplay With Left Ventricular Geometry

BackgroundThe relationships of left ventricular (LV) longitudinal and circumferential systolic dysfunction with diastolic performance in hypertensive patients have never been compared.Methods and ResultsIn 532 asymptomatic hypertensive patients, circumferential function was assessed with the use of midwall fractional shortening (mFS) and stress-corrected mFS (SCmFS), whereas longitudinal function was assessed with the use of left atrioventricular plane displacement (AVPD) and systolic mitral annulus velocity (s′). Early diastolic annular velocity (e′) and the E/e′ ratio were measured. Global longitudinal and circumferential strain were determined in a subset of 210 patients. e′ was linearly related to all systolic indexes (AVPD: R = 0.40; s′: R = 0.39; mFS: R = 0.16; SCmFS: R = 0.17; all P < .0001), but the correlations were stronger with longitudinal indexes than with circumferential ones (P < .0001). E/e′ was nonlinearly related to AVPD (R = −0.49; P < .0001) and s′ (R = −0.34; P < .0001) and showed no relationship with mFS and SCmFS. Longitudinal indexes were superior to circumferential ones in predicting e′ <8 cm/s, E/e′ <8, and E/e′ ≥13. The effect of LV geometry on LV diastolic function was evident among patients with preserved systolic longitudinal function, but was blunted among patients with impaired longitudinal function. In multivariable analyses, only longitudinal indexes remained associated with e′ and E/e′. Analyses using strains provided similar results.ConclusionsIn asymptomatic hypertensive subjects, LV diastolic performance is independently associated with longitudinal systolic dysfunction, but not with circumferential systolic dysfunction. Subtle longitudinal systolic impairment plays a role in mediating the effect of LV geometry on diastolic performance. These findings may support the need of critically revising the concept of isolated diastolic dysfunction in these patients.     

Blood Pressure Variability and Left Ventricular Mass Index in Children

Clinical implications of blood pressure variability (BPV) on subclinical organ damage in children are unknown. The authors sought to explore the potential utility of two newly derived BPV indices: weighted standard deviation (wBPSD) and real average variability (ARV), as well as two standard ambulatory blood pressure indices: average 24‐hour systolic blood pressure (SBP) and 24‐hour SBP load, to identify children at high risk for left ventricular (LV) hypertrophy (LVH). The study group consisted of 67 consecutive children who were referred to our institution for evaluation of suspected hypertension. LV mass was estimated by M‐mode echocardiography using Devereux's formula according to the Penn convention and indexed for height^2.7. We found a statistically significant, positive correlation between 24‐hour wBPSD and LV mass index (LVMI) (ρ=0.389; P=.002) and no correlation between 24‐hour ARV and LVMI (P>.05). However, partial correlation analysis of 24‐hour wBPSD adjusted for body mass index (BMI) and LVMI showed only a weak correlation (ρ=0.3; P=.022). By using multiple linear regression analysis in a model with LVMI as a dependent variable and 24‐hour wBPSD, 24‐hour ARV, and BMI as independent variables, only BMI showed statistically significant independent positive associations with LVMI (P=.028). Results of our study showed that currently used BPV indices (24‐hour wBPSD and 24‐hour ARV) are not clinically reliable parameters to identify children at risk for LVH. Apparent contribution of the 24‐hour wBPSD parameter to LVMI is negligible and is secondary to its close correlation with BMI (ρ=0.335 P=.009).     

306例高血压患者左室心肌重量影响因素分析

调查306例高血压患者影响左心室心肌重量指数相关因素，进行配对病例单因素及多因素逐步回归分析，认为SBP与体重指数、未坚持降压治疗及高血压家族史为高血压患者左心室心肌重量指数升高最重要的相关因素（相关回归系数分别为0．2358，0．1905，0．3161，0．2271）。     

高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病（essentialhypertension,EH）左心室肥厚（leftventricularhypertrophy,LVH)与脉压（pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查,测量并计算92例高血压患者脉压,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异（P<0.01）,左室重量指数与脉压（r=0.3,P<0.01）和主动脉根部内径（r=0.5,P<0.01)之间存在一定的正相关。结论　脉压和大动脉内径增大,提示大动脉顺应性下降,在高血压左室肥厚中起重要作用。     

高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病 (essentialhypertension ,EH)左心室肥厚 (leftventricularhypertrophy ,LVH)与脉压 (pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查 ,测量并计算 92例高血压患者脉压 ,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组 ,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异 (P <0 0 1) ,左室重量指数与脉压 (r =0 3,P <0 0 1)和主动脉根部内径 (r =0 5 ,P <0 0 1)之间存在一定的正相关。结论　脉压和大动脉内径增大 ,提示大动脉顺应性下降 ,在高血压左室肥厚中起重要作用     

Association Between Renal Function and Cardiovascular Disease in Patients With Left Ventricular Hypertrophy. VIIDA Study

The association between renal dysfunction and cardiovascular risk in patients with hypertension and left ventricular hypertrophy (LVH) has not been specifically studied. The aim of this study was to analyze the association between renal function and the presence of cardiovascular disease in this group of patients. Hypertensive patients with electrocardiographic criteria for LVH were recruited in cardiology outpatient clinics from April 2003 until November 2004. Epidemiologic variables were determined, together with an estimation of the glomerular filtration rate by means of the Modification of Diet in Renal Disease (MDRD) and Crockoft-Gault equations. The population was classified according to the kidney disease stages of the National Kidney Foundation. A total of 3962 patients were included in the study, 47.6% of which were female, with a mean age of 67.2 years. The prevalence of established cardiovascular disease was higher in patients with a depressed glomerular filtration rate (68.3% vs 54.9%; P <.001). After adjusting for age, sex, body mass index, diabetes, smoking habits, and systolic and diastolic blood pressures, the stage of renal function was an independent predictor of the presence of cardiovascular disease (odds ratio, 1.5 [confidence interval, 1.19–2.02]; 2.1 [1.55–2.89]; and 2.6 [1.52–4.42], respectively, for stages 2, 3, 4–5, compared with stage 1). In hypertensive patients with electrocardiographic criteria for LVH, the determination of the glomerular filtration rate by the MDRD or Crockoft equations is easy and identifies a progressive and independent increase in cardiovascular risk.     

Left Ventricular Hypertrophy and Hypertension

The level of left ventricular (LV) mass as measured by echocardiography or other techniques in hypertensive patients reflects the integrated effects of the level of arterial pressure, the concomitant volume load imposed on the heart, and of alterations in arterial waveform morphology as well as of body size and non-hemodynamic variables. The LV may respond to these stimuli by concentric or eccentric hypertrophy or by the recently-described pattern of concentric remodeling, in which LV mass is normal but relative wall thickness is increased. The are strong parallelisms between increases in cardiac and systemic arterial wall thicknesses, and patients with discrete atheromas detectable by carotid ultrasound have elevated LV masses. Patients with eccentric and concentric LV hypertrophy have two to four-fold increases in the incidence of cardiovascular morbid events compared to hypertensive patients with normal LV geometry, and the change in LV mass during treatment has been associated with the risk of subsequent morbidity in initial studies. In contrast to the strong predictive power of LV geometric assessment, use of indirect measures of target organ status in the WHO systm for classification of the severity of hypertension does not improve on the prediction of prognosis that can be obtained by consideration of the level of arterial pressure. Current evidence suggests that evaluation of LV geometry may contribute to improved clinical decision-making in situations where more precise stratification of risk would clarify whether or not to institute treatment, or whether it should be with drugs or non-pharmacologic measures.     

Angiotensin II Type 1 Receptor Gene Polymorphism Is Associated With Increase of Left Ventricular Mass But Not With Hypertension

A genetic epidemiologic approach is useful to elucidate the genes responsible for hypertension. Genetic analyses of the components of the renin-angiotensin system have succeeded in showing an association between their polymorphism and hypertension. Recently, two types of angiotensin II receptor were cloned and characterized. To examine the genetic contribution of angiotensin II type 1 receptor (AT₁) and type 2 receptor (AT₂) genes in human essential hypertension, a case-control study was performed in Japanese subjects. The study comprised 321 subjects with hypertension who satisfied the criteria for essential hypertension, together with 215 age and sex matched controls. The significance of the differences in genotype distribution between hypertensive and normotensive subjects was examined by χ² analysis. Neither AT₁ nor AT₂ gene variants were associated with human essential hypertension in the Japanese subjects. However, the AT₁ receptor gene polymorphism was associated with left ventricular mass index in normotensive subjects. The study results suggest that gene polymorphisms of both angiotensin II receptors are not directly involved in the increase of genetic risk for hypertension, but that the AT₁ receptor gene might contribute genetically to the increase of left ventricular mass.     

原发性高血压左心室肥厚与心律失常的关系

目的探讨原发性高血压(EH)病人左心室肥厚(LVH)与心律失常的关系.方法采用24 h动态心电图(DCG)、超声心动图(UCG)对156例EH病人进行检查并分组分析.结果LVH组室性心律失常和复杂室性心律失常的发生率显著高于非LVH组(P＜0.01);房性心律失常的发生率显著高于室性心律失常(P＜0.01).结论左心室肥厚是导致室性心律失常的危险因素之一.     

胰岛素抵抗与原发性高血压患者合并左心室肥厚的关系

目的：研究胰岛素抵抗与原发性高血压合并左心室心肌肥厚的关系。　　方法：选择４４例原发性高血压（ＥＨ）患者为ＥＨ组,３６ 例ＥＨ合并左心室肥厚（ＬＶＨ）患者为ＥＨ＋ ＬＶＨ组和３８ 例正常血压者为正常血压组。用二维超声心动图测定上述３组左心室重量指数、总心室壁厚度和相对心室壁厚度及血糖、胰岛素并计算胰岛素敏感指数。　　结果：方差分析发现正常血压组和ＥＨ组中胰岛素敏感指数明显高于ＥＨ＋ ＬＶＨ组（Ｐ＜ ０．０５）。在直线回归分析中发现胰岛素敏感指数与左心室重量指数明显负相关（ｒ＝ － ０．３０１,Ｐ＜ ０．０５）。胰岛素敏感指数与总心室壁厚度明显负相关（ｒ＝ － ０．２８８,Ｐ＜ ０．０５）。逐步回归分析提示左心室重量指数与胰岛素敏感指数、高血压年限、总外周血管阻力显著相关（Ｒ２＝ ０．２９３５,Ｐ＜ ０．０１）。　　结论：提示胰岛素抵抗在原发性高血压合并ＬＶＨ的发病机制中具有重要的作用