老年高血压伴左室肥厚对左心功能的影响

目的 :探讨老年高血压伴左室肥厚对心功能的影响。方法 :应用核素心血池扫描的方法 ,对老年高血压伴左室肥厚和无左室肥厚的患者 ,进行了左室射血分数 (LVEF)、左室高峰射血率 (PER)、左室高峰充盈率(PFR)、1/ 3充盈分数 (1/ 3FF)及相角程 (PA)的测定 ,并进行比较。结果 :伴左室肥厚的患者PFR、1/ 3FF明显低于无左室肥厚的患者 ,PA明显高于无左室肥厚的患者。结论 :老年高血压伴左室肥厚对心功能的影响 ,主要表现为对舒张功能的影响 ;左室肥厚导致的心室肌纤维化、顺应性下降和运动协调性异常 ,是影响舒张功能的重要原因     

Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension

BACKGROUND: Arterial hypertension determines distinct adaptive left ventricular geometric responses, which may differently affect left ventricular function and left atrial performance. OBJECTIVES: In this study, the effect of left ventricular geometry on left atrial size and function, and the relationship between left atrial size and left ventricular mass were assessed in 336 patients with systemic arterial hypertension who had undergone Doppler echocardiography. METHODS AND RESULTS: Patients were classified into concentric (110 patients with concentric left ventricular geometry defined as relative wall thickness > or = 0.44) and eccentric groups (226 patients with relative wall thickness < 0.44). Comparison to the latter, the former had greater left atrial size, left atrial ejection force, left ventricular mass and lower left ventricular midwall fractional shortening. Left ventricular concentric, rather than eccentric, geometry emerged by multivariate analysis as a factor independently associated with the highest degree of left atrial ejection force. Left atrial size was positively related to left ventricular mass in the whole population (r = 0.65, SEE = 6 ml, P < 0.00001). This relationship was maintained in the subgroups with concentric (r = 0.65, SEE = 6 ml, P < 0.00001) or eccentric geometry (r = 0.59, SEE = 6 ml, P < 0.00001). CONCLUSIONS: Our results indicate that the relationship of left ventricular geometry to both left atrial size and ejection force in hypertensive patients is relevant. Concentric left ventricular geometry is associated with greater left atrial size and ejection force than eccentric geometry, suggesting that increased left ventricular stiffness has a greater effect in stimulating left atrial performance than left ventricular end-systolic stress. The degree of left atrial enlargement similarly depends on left ventricular mass in patients with concentric and eccentric geometry.     

Left ventricular midwall function improves with antihypertensive therapy and regression of left ventricular hypertrophy in patients with asymptomatic hypertension

Recent evidence suggests that regression of left ventricular hypertrophy (LVH) with antihypertensive therapy improves prognosis. The mechanism for this benefit is unknown but may be related to effects on myocardial performance. Midwall fractional shortening (mFS) is often depressed in patients with asymptomatic hypertension, is associated with LVH, and is a potent, independent predictor of outcome. We therefore examined whether antihypertensive therapy may improve midwall performance. mFS as well as conventional echocardiographic parameters were measured serially among 29 hypertensive persons during 6 months of drug therapy. Stress-adjusted and absolute midwall function improved by 10% and 11%, respectively (p <0.05), whereas no significant changes were detected in other measures of chamber function. Improvement in function was more pronounced in patients with concentrically remodeled ventricular geometry and in those who achieved greater reductions in left ventricular (LV) mass. Antihypertensive therapy and LV mass regression is associated with demonstrable improvements in cardiac performance when assessed using mFS. Determinations of mFS may have a promising role in identifying patients with early hypertensive heart disease, tracking responses to therapy, and in elucidating the potential beneficial effects associated with LV mass regression.     

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。     

The effects of simvastatin on left ventricular hypertrophy and left ventricular function in patients with essential hypertension

This study is to evaluate the effects of Simvastatin on left ventricular hypertrophy and left ventricular function in patients with essential hypertension. Untreated or noncompliance with drug treatment patients with simple essential hypertension were treated with a therapy on the basis of using Telmisartan to decrease blood pressure (BP). There were 237 patients who had essential hypertension combined with left ventricular hypertrophy as diagnosed by echocardiography, taken after their BPs were decreased to meet the values of the standard normal. Among them, there were only 41 out of the original 237 patients, 17.3%, who had simple essential hypertension combined with left ventricular hypertrophy without any other co-existing disease. They were the patients selected for this study. All patients were randomly, indiscriminately divided into two groups: one was the control group (Group T), treated with the Telmisartan-based monotherapy; the other was the target group (Group TS), treated with the Telmisartan-based plus simvastatin therapy. The changes of left ventricular hypertrophy and left ventricular function were rediagnosed by echocardiography after 1 year. The results we obtained from this study were as follows: (i) The average BPs at the beginning of the study, of simple essential hypertension combined with left ventricular hypertrophy, were high levels (systolic blood pressure (SBP) 189.21 ± 19.91 mm Hg, diastolic blood pressure 101.40 ± 16.92 mm Hg). (ii) The Telmisartan-based plus simvastatin therapy was significantly effective in lowering the SBP (128.26 ± 9.33 mm Hg vs. 139.22 ± 16.34 mm Hg). (iii) After the 1-year treatment, the parameters of left ventricular hypertrophy in both groups were improved. Compared to group T, there were no differences in the characteristics of the subjects, including interventricular septum, left ventricular mass, left ventricular mass index, ejection fraction, left atrium inner diameter at baseline. The patients' interventricular septum (Group TS 10.30 ± 1.80 mm vs. Group T 10.99 ± 1.68 mm, P < .05), LVM (Group TS 177.43 ± 65.40 g vs. Group T 181.28 ± 65.09 g, P < .05), and LVMI (Group TS 100.97 ± 37.33 g/m(2) vs. Group T 106.54 ± 27.95 g/m(2), P < .05), all dropped more prominently (P < .05) in group TS; the ejection fraction rose more remarkably in group TS (Group TS: 57.50 ± 16.41% to 65.43 ± 11.60%, P < .01 while showing no change in Group T); the left ventricular hypertrophy reversed more significantly and the left ventricular systolic function improved more. (iv) The left atrium inner diameter of Group TS decreased (P < .01), the ratio of E/A, which indicates the left ventricular diastolic function, continued to drop further, showing no change to the trend of left ventricular diastolic function declination. Patients who have hypertension with left ventricular hypertrophy usually suffer other accompanying diseases at the same time. Telmisartan-based plus Simvastatin treatment can significantly reduce SBP, reverse left ventricular hypertrophy, improve the left ventricular systolic function, but it has no effect on reversing the left ventricular diastolic function. This experiment indicated that Simvastatin can reverse left ventricular hypertrophy and improve left systolic function.     

Effects of nitrendipine on diastolic left ventricular function and hypertrophy in patients with hypertension

To assess the effects of antihypertensive therapy on the heart, left ventricular mass and performance indices (determined by M-mode and pulsed Doppler echocardiography) were compared before and after 4-5 months of nitrendipine therapy in 19 primary hypertensive patients (stage I and II). MAP was reduced from 17.1 +/- 1.7 to 14.5 +/- 1.7 kPa (128.5 +/- 12.7 to 109.0 +/- 13.1 mm Hg), P less than 0.001. The heart rate increased from 68 +/- 8 to 70 +/- 8 beats/min (P greater than 0.05). None of the indices for systolic function (SV, SI, CO, CI, EF, FS) changed significantly (P greater than 0.05). But the indices for diastolic function (RFF, RFR, VLef, IRP, EFv, A/E) improved remarkably (P less than 0.001 or 0.05). Furthermore, a positive correlation between the increasing rate of VLef and decreasing rate of MAP (r = 0.58, P less than 0.005) was noticed. Therefore, the decreasing in arterial pressure is considered as a major relative factor in the improvement of diastolic dysfunction. The patients were divided into two groups according to LVMI: group A, 11 patients with LVMI greater than or equal to 125 g/m2; while group B, 8 patients with LVMI less than 125 g/m2. The LV diastolic relaxation index IRP improved to a greater degree in group B (P less than 0.05), although the reduction of MAP was more markable in group A (P less than 0.05). This means that factors other than arterial pressure may influence the LV diastolic relaxation. In group A, the LVMI decreased from 155.1 +/- 29.9 to 144.4 +/- 33.0 g/m2 (a reduction of 7.0 +/- 9.0%). It suggests that LV hypertrophy can be "reversed" following nitrendipine therapy in some of the hypertensive patients.     

氯沙坦与福辛普利逆转原发性高血压左心室肥厚的对比研究

目的 :对比研究应用氯沙坦和福辛普利逆转原发性高血压 (EH)伴左心室肥厚 (LVH)的作用。方法 :将 12 0例EHLVH患者随机分为氯沙坦组 (n =6 0 )和福辛普利组 (n =6 0 ) ,于服药前及服药 6个月后分别测定血压、室间隔厚度 (IVST)、左心室后壁厚度 (PWT)、左心室舒张末期直径 (LVDd)、左心室重量指数 (LVMI)、左心室射血分数 (LVEF)、心排血量 (CO)和A/E峰值。结果 :两组患者经治疗后血压、IVST、PWT、LVDd、LV MI、A/E峰值均显著降低 (均P <0 .0 1) ,而LVEF、CO无显著变化 (P >0 .0 5 )。结论 :氯沙坦与福辛普利均能逆转LVH ,明显改善左心室舒张功能     

一氧化氮、醛固酮对高血压左室肥厚及左室舒张功能的影响

目的:探讨一氧化氮(NO)、醛固酮(ALD)在高血压左室肥厚(LVH)形成中的作用及对左室舒张功能的影响。方法:以超声心动图检查55例原发性高血压(EH)患者和30例正常人并计算左室重量指数(LVMI),测定左室舒张功能等指标,并测定空腹血清NO、ALD水平,进行组间比较。结果:EH组与正常人相比NO水平降低、ALD 水平升高,左室舒张功能降低(P均<0.01)。EH-LVH组与EH组相比NO水平降低、ALD水平升高更明显(P< 0.01)。NO、ALD与LVMI相关系数(r)分别为-0.46和0.50(P<0.05)。NO、ALD与左室舒张指标E/A和PFR/ PAFR的,r分别为0.37、0.43、-0.42、-0.37(P<0.05)。结论:原发性高血压患者NO、ALD水平与LVMI和左室舒张功能减退呈显著相关性。     

Heart rate variability and left ventricular diastolic function in patients with borderline hypertension with and without left ventricular hypertrophy

The relationships between heart rate variability (HRV), left ventricular mass and diastolic function in borderline hypertensive patients (BHT) were evaluated. 24 h Holter electrocardiogram (ECG) and blood pressure (BP) monitoring, M and 2 D echocardiogram and Doppler analysis in 42 BHT with and without left ventricular hypertrophy (LVH) and in 20 normotensive controls were assessed. From 24-h ECG, time domain indexes of HRV were calculated. Standard Deviation of all Cycles (SDNN) and Standard Deviation of the means of heart periods over five-minute intervals (SDANN) were significantly reduced in BHT with LVH but not in BHT without LVH. No significant differences of short-term variability measures were detectable, although a progressive decrease among control subjects and BHT with and without LVH was observed. Diastolic left ventricular compliance evaluated by early to late transmitral flow velocity ratio (E/A ratio) significantly declined from normotensive subjects to BHT with LVH. There was a significant positive correlation between E/A and SDNN and SDANN throughout all studied groups. This indicates that BHT with LVH has a reduced HRV compared to other groups. This impairment is probably related to left ventricular mass and left ventricular filling abnormalities.     

Effects of indapamide on left ventricular mass and function in systemic hypertension with left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is frequently associated with hypertension and constitutes a major cardiovascular risk factor, the reduction of which should be considered when initiating antihypertensive therapy. To assess the effects of indapamide on LVH, 18 hypertensive patients were included in the study (11 men and 7 women, age 53.6 +/- 2.9 years, mean +/- standard deviation) whose supine diastolic blood pressure was greater than 95 mm Hg without (n = 11) or with (n = 7:6 beta blockers, 1 calcium antagonist) antihypertensive therapy. All presented with LVH, echocardiographically defined by a left ventricular mass index greater than 110 g/m2. After a 2-week preinclusion period, all patients received indapamide, 2.5 mg/day, for a period of 6 months. Physical examination including blood pressure measurement was performed on selection (M-1/2), before (M0), and after 1 (M1), 3 (M3) and 6 (M6) months of indapamide treatment, and echocardiography was performed at M0 and M6. Quality of life was evaluated by means of questionnaires completed by the patient and the physician, and a visual analog scale was completed by the patient at M-1/2, M0 and M6. All clinical parameters remained stable during the 2-week preinclusion period. Indapamide administration induced a highly significant reduction in both supine systolic and diastolic blood pressures from 173.9 +/- 2.9/100.5 +/- 1.2 mm Hg at M0 to 150.9 +/- 1.9/90.5 +/- 1.3 mm Hg at M1 (p less than 0.001), and 145.0 +/- 1.7/86.0 +/- 1.5 mm Hg at M6 (p less than 0.001). Similar favorable effects were observed in the upright position.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of hypertension in patients with left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is a cardinal manifestation of organ damage in patients with arterial hypertension. Identifying LVH is a fundamental step in evaluating hypertensive patients, because clinical and epidemiologic studies have shown this condition has a strong independent adverse prognostic significance. LVH is an integrated marker of cardiovascular risk, reflecting hypertension’s hemodynamic and nonhemodynamic effects on the heart. Reversing LVH is an intermediate goal of antihypertensive therapy. Pharmacologic strategies to reverse LVH should be based on combining two or more drugs: a renin-angiotensin system blocker (ie, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist), and a calcium antagonist or low-dose diuretic. Successful therapeutic plans should also include nonpharmacologic interventions to promote LVH regression.     

缬沙坦对原发性高血压左心室肥厚及舒张功能的影响

目的 评价缬沙坦对高血压患者左心室肥厚及左心室舒张功能的影响。方法 选原发性高血压并左心室肥厚患者48例,随机分为缬沙坦治疗组和硝苯地平缓释片治疗组（对照组）,治疗6个月,控制收缩期血压低于或等于140 mm Hg（1mm Hg=0.133kPa）,舒张期血压低于或等于95 mm Hg。于治疗前、治疗3个月、6个月作体格检查、血生化及心脏超声检查,记录心率、收缩压、舒张压、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、左心室射血分数、舒张早期和晚期最大速度比值（E/A比值）,计算左心室重量指数。结果 调整用药后两组患者血压均达目标值;治疗3个月后两组病人左心室重量指数和E／A即显示差异,但缺乏统计学意义;治疗6个月后缬沙坦治疗组的左心室重量指数和E／A比值较对照组改善明显,而两组治疗前后左心室射血分数均无明显变化。结论 相对于硝苯地平缓释片,缬沙坦对于原发性高血压患者的左心室肥厚和左心室舒张功能有更明显的改善,这种受益是独立于其降压作用之外的。     

Prevalence of paroxysmal atrial fibrillation depending on the regression of left ventricular hypertrophy in arterial hypertension.

Arterial hypertension (HTN) represents one of the major causes of atrial fibrillation, a cardiac arrhythmia with high prevalence and comorbidity. The aim of this study was to investigate whether paroxysmal atrial fibrillation can be treated by the regression of left ventricular hypertrophy achieved by antihypertensive therapy. Included in the present study were 104 patients who had had HTN for more than 1 year. None of them suffered from coronary heart disease. All patients were investigated by 24-h Holter ECG and echocardiography at baseline and after a mean of 24 months. Patients were divided into two groups: group A consisted of those (53.8%) who showed a regression of the left ventricular muscle mass index (LVMMI) during the follow-up (154.9+/-5.1 vs. 123.5+/-2.8 g/m(2)), and group B those (45.2%) who showed a progression of LVMMI (122.2+/-3.2 vs. 143.2+/-3.2 g/m(2)). In group A the prevalence of atrial fibrillation decreased from 12.5% to 1.8% (p<0.05), while it was increased in group B from 8.5% to 17.0%. The left atrial diameter was reduced following antihypertensive therapy in group A from 39.1+/-5.3 mm to 37.4+/-4.6 mm (p<0.01) and increased in group B from 37.0+/-0.7 mm to 39.0+/-0.9 mm (p<0.01). We conclude that a regression of the left ventricular muscle mass leads to a reduction of left atrial diameter and consecutively to a decrease in the prevalence of intermittent atrial fibrillation. This may be explained by a better left ventricular diastolic function following decreased vascular and extravascular resistance of the coronary arteries. This relation shows the benefits of causal antihypertensive therapy for the treatment of paroxysmal atrial fibrillation.     

非洛地平和伊贝沙坦对原发性高血压左室肥厚的逆转作用

目的 :观察非洛地平和伊贝沙坦治疗原发性高血压 (EH)的疗效及对左室肥厚的作用。方法 :将 10 4例EH伴左室肥厚的患者随机分为非洛地平组和伊贝沙坦组 ,于服药前及服药后 6个月、12个月、2 4个月分别测定血压、左室舒张末内径 (LVDd)、舒张期室间隔厚度 (IVST)、左室后壁厚度 (LVPWT)、左室射血分数 (LVEF)、左室高峰射血率 (LPER)、左室高峰射血率时间 (LTPER)、左室高峰充盈率 (LPFR)和左室高峰充盈率时间(LTPFR)。结果 :治疗后 ,两组血压较治疗前显著下降 (P <0 .0 5 ,或P <0 .0 1) ,两组治疗前后比较LVEF、LPER和LTPER均无变化 (P >0 .0 5 ) ,而LPFR升高和LTPFR则明显降低 (P <0 .0 5 ,或P <0 .0 1) ;左室重量指数 (LVMI)、LVDd、IVST、LVPDWT在伊贝沙坦组明显下降 (P <0 .0 5 ,或P <0 .0 1) ,而在非洛地平组则无变化 (P >0 .0 5 )。结论 :非洛地平和伊贝沙坦均能有效控制血压 ,但伊贝沙坦能明显减轻左室肥厚     

Effects of atenolol on left ventricular hypertrophy and early left ventricular function in essential hypertension

Echocardiographic studies of left ventricular (LV) hypertrophy indicate clinical benefits of antihypertensive therapy. Therefore, M-mode and Doppler techniques were used to assess changes in LV hypertrophy after 10, 30 and 50 weeks of atenolol therapy (50 or 100 mg once daily) in 19 patients with essential hypertension. After 50 weeks of atenolol treatment, the most notable changes were: for M-mode parameters, increases (p less than 0.05) in diastolic LV internal dimension, radius to thickness ratio and stroke volume, and decreases (p less than 0.01) in total wall thickness and heart rate; for Doppler parameters, increases (p less than 0.01) in slope and peripheral resistance, and decreases (p less than 0.01) in heart rate, stroke volume and cardiac output. The decreased total wall thickness and increased radius to thickness ratio suggest a trend toward regression of LV hypertrophy. These findings, along with improvements in blood pressure, pulse and exercise stress tests, indicate potential benefits of atenolol in managing patients with essential hypertension and LV hypertrophy.     

Influence of acute arterial hypertension on myocardial infarct size in dogs without left ventricular hypertrophy

During acute myocardial infarction an increase in arterial pressure is common in patients who were previously normotensive and, therefore, do not have left ventricular hypertrophy. However, the effect of hypertension on infarct size in the absence of hypertrophy is uncertain. Thus, 32 open chest dogs underwent a 2 hour occlusion of the mid-left anterior descending coronary artery followed by 3 hours of reperfusion. Immediately after occlusion, 14 dogs were randomized to a hypertension group (intravenous phenylephrine infusion starting 5 minutes after occlusion and terminating at the time of reperfusion, with heart rate kept constant by atrial pacing) and 18 dogs to a control group (equivalent volumes of saline solution intravenously). Twelve of the 32 dogs were excluded from analysis because they developed ventricular fibrillation during coronary occlusion or reperfusion. In the hypertension group (n = 10), the mean arterial pressure increased significantly within 10 minutes of coronary occlusion (146 +/- 7 versus 109 +/- 11 mm Hg in 10 control dogs, p less than 0.01) and was maintained approximately 40 mm Hg higher than in the control group (p less than 0.01) throughout the ischemic period. Heart rate was similar in the two groups throughout the experiment. After the dogs were sacrificed, the region normally supplied by the occluded artery (anatomic "region at risk") was identified by simultaneous perfusion of the aortic root and the coronary artery distal to the occlusion. The heart was sectioned transversely and stained with triphenyltetrazolium-chloride. The infarcted area and the anatomic risk area were determined by video planimetry.(ABSTRACT TRUNCATED AT 250 WORDS)