Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) (the E/A ratio), peak early diastolic mitral annular velocity (e') and the E/e' ratio. Although LVMI, E/A and e' did not differ between the two groups, E/e' was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.     

左室肥厚与左心室舒张功能不全相关性的研究

目的 探讨心脏左室壁肥厚,评价左室舒张功能不全的可行性。方法 对15例非左心室肥厚（对照组：室壁厚度≤11mm）和15例左心室肥厚（LVH组：室壁厚度≥12mm）高血压病人,采用胸骨旁长轴切面测量室间隔（IVSd）及左室后壁厚度（LVPWd）;在心尖四腔切面,常规测量二尖瓣血流频谱E峰、A峰及E／A比值。选取室间隔、左室侧壁的二尖瓣瓣环水平为取样点,使用组织多普勒（DTI）测量心肌舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）及Ve/Va比值。30例受试者均行冠脉造影,测量左室舒张末压（LVEDP）。结果 与对照组比较,LVH组的IVSd、LVPWd、LVEDP明显增大,P〈0．01;而E／A、Ve／Va明显减小（P〈0．01）。IVSd和LVPWd与LVEDP呈直线正相关（r分别为0．79和0．77,P〈0．001）。IVSd与V e/Va和E／A呈直线负相关（r分别为-0．77和-0．70,P〈0．001）;LVPWd与Ve/Va和E／A亦呈直线负相关（r分别为-0．66和-0．56,P〈0．001）。结论 左室肥厚可以作为评价左室舒张功能的简便、可靠指标。     

普伐他汀治疗高血压伴左室肥厚舒张功能不全的疗效

目的观察普伐他汀对高血压伴左室肥厚舒张功能不全的疗效。方法选择高血压伴左室肥厚舒张功能不全的患者86例,随机分成普伐他汀组和对照组,每组43例,普伐他汀组在标准降压的基础上加用普伐他汀20 mg,每天1次。观察治疗前后心脏结构和舒张功能的变化。结果治疗6个月后,在普伐他汀组中,室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWD）明显变薄,E峰与A峰的比值（E/A）明显升高（P〈0.05）。与对照组比较,IVSD、LVPWD明显变薄,E/A明显升高（P〈0.05）。结论普伐他汀能有效减轻左心室肥厚,明显改善舒张功能。     

On the connection between left ventricular hypertrophy and diastolic dysfunction in arterial hypertension

AIM: To evaluate relationships between arterial pressure (AP), myocardial mass of the left ventricle (LVMM) and left ventricular diastolic function (LVDF) in patients with hypertension stage I and II. MATERIAL AND METHODS: 89 hypertensive patients and 30 healthy subjects (control group). RESULTS: Initial defects in LVDF in the absence of its hypertrophy were detected already in hypertension stage I. At hypertension stage II diastolic dysfunction occurs in marked left ventricular hypertrophy. A close correlation exists between LVMM and LVMM index, on the one hand, and parameters of diastolic dysfunction, on the other hand. CONCLUSION: There is a close correlation between left ventricular hypertrophy and its diastolic dysfunction.     

QT-interval variability and autonomic control in hypertensive subjects with left ventricular hypertrophy

Left ventricular hypertrophy is a risk factor for sudden death. Malignant ventricular arrhythmias originate from altered cardiac repolarization. Ample data have described spatial abnormalities in cardiac repolarization [QT interval (QT) dispersion] in subjects with hypertension; more data are needed on temporal changes. This study was designed to assess the QT variability index (QTVI), the slope between QT and the RR interval (QT-RR(slope)) and spectral QT variability in subjects with arterial hypertension. The results were compared with those from a population at high risk of sudden death, i.e. patients with hypertrophic cardiomyopathy (HCM) who had received an implantable cardioverter/defibrillator (ICD), and those from normotensive control subjects. A total of 44 hypertensive subjects, six patients with HCM and an ICD and 33 control subjects underwent simultaneous short-term recording (256 beats) of QT, RR and systolic blood pressure variability, in the supine position, during controlled breathing. QTVI and spectral components of QT variability in the hypertensive group were significantly higher than in normotensive control subjects (P<0.001), but significantly lower than in patients with HCM and an ICD (P<0.001). The severity of left ventricular hypertrophy correlated significantly with QTVI and the ratio of low-frequency (LF) to high-frequency (HF) power obtained from the RR variability spectra (RR(LF/HF), slope=0.24, P<0.05; QTVI, slope=4.06, P<0.0001; intercept, slope=2.40, P<0.05; chi(2)=38.8; P<0.0001). The QT--RR slope was significantly higher only in patients with HCM and an ICD (P<0.001). In conclusion, the increased QTVI and the correlation of this index with left ventricular hypertrophy indicates that hypertension increases temporal cardiac repolarization abnormalities. At the level of the cardiac sinus node, this alteration is associated with increased sympathetic and reduced vagal modulation. As already noted in patients with HCM, the increased QTVI could be a factor responsible for triggering malignant ventricular arrhythmias in subjects with hypertension.     

福辛普利对老年高血压心脏病左室肥厚和舒张功能的作用

目的 观察福辛普利对老年高血压心脏病患者的降压疗效及其对左室肥厚的逆转和舒张功能的改善作用。方法 选择老年高血压伴左室肥厚患者33例,给予口服福辛普利lOmg,每日1次,总疗程3个月。以彩色多普勒超声心动图观察治疗前、后心脏结构和舒张功能的改变情况。结果 老年高血压心脏病患者治疗后收缩压、舒张压均有所下降。室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWD）较治疗前明显减轻。结论 福辛普利能有效逆转高血压患者左心室肥厚,明显改善左心室舒张功能。     

高血压左室肥厚及舒张功能不全与血浆B型脑钠肽关系

目的:探讨原发性高血压患者血浆B型脑钠肽与左室肥厚及舒张功能不全的关系。方法:原发性高血压患者87例,分单纯高血压不伴左室肥厚组40例,高血压伴左室肥厚组47例,其中高血压伴左室肥厚组无舒张功能不全21例,伴舒张功能不全26例。另有33例健康者为对照组。采用放射免疫法测定B型脑钠肽。结果:高血压伴左室肥厚组血浆B型脑钠肽显著高于高血压不伴左室肥厚组(P<0.05),同时伴舒张功能不全组患者血浆B型脑钠肽显著高于无舒张功能不全组患者(P<0.05),高血压不伴左室肥厚组患者血浆B型脑钠肽与对照组相似(P>0.05)。结论:高血压左室肥厚合并左室舒张功能不全患者血浆B型脑钠肽升高,B型脑钠肽检测有助于临床早期诊断左室舒张功能不全。     

实时三维超声心动图评价高血压左心室舒张功能的研究

目的：应用实时三维超声心动图技术评价高血压患者左心室舒张功能。方法：应用实时三维超声心动图、组织多普勒技术分别测量20例健康者和20例高血压患者的左室重量（LVM）和左室充盈率（PFR）及左室壁17节段的节段每搏量（rSV）、节段舒张末容积（rEDV）、节段充盈率（rPFR）,左心室间隔、侧壁基底段舒张早期峰值速度（Ea）和舒张晚期峰值速度（Aa）并计算其比值（Ea/Aa）。结果：40例受测者均获得了具有清晰内膜边界的二维及实时三维图像和17节段容积-时间曲线。两组间左室充盈率（PFR）和Ea/Aa比值及左心室17节段的rSV、rEDV、rPFR测值间差异有统计学意义（P<0.05）。结论：高血压患者与正常人左心室舒张功能及左心室壁节段舒张功能存在差异,实时三维超声心动图是一种可行的、能准确定量评价左室舒张功能的新技术。     

厄贝沙坦对左室肥厚及左室舒张功能影响的观察

目的采用超声心动图技术观察厄贝沙坦对左室肥厚及左室舒张功能的影响,以期为临床寻找能逆转左室肥厚、改善左室舒张功能的有效药物。方法选择经超声心动图检查确诊为左室肥厚的高血压患者50例,在停用其他降压药1周后,服用厄贝沙坦,维持用药20周,每天测血压2次;治疗前后由专人进行超声心动图检查。结果 50例患者治疗后血压平均下降(14.2±7.2)mmHg/(7.9±3.8)mmHg(P<0.01);治疗后与治疗前比较,左室舒张功能改善,差异有统计学意义(P<0.01)。结论厄贝沙坦不仅24h平稳降压,且可逆转左室肥厚、改善左室舒张功能,副作用少,是临床可取的降压药。     

氯沙坦对高血压左室肥厚和左室舒张功能的影响

目的：研究氯沙坦对早期高血压心室肥厚和左室舒张功能的影响。方法：测定治疗前后血浆肾素活性、血管紧张素Ⅱ、醛固酮含量。左心室肥厚指标及心肌舒张功能用彩色多谱心动仪测定。结果：治疗8周后血浆醛固酮及血清Ⅲ型前胶原的含量降低，快速充盈峰速（E）与心房收缩峰速（A）之比升高，而室间隔厚度（IVS）、左室后壁厚度（PWT）及左室心肌重量指数（LVMI）治疗前后未见明显变化。结论：氟沙坦在有效降低血压的同时，具有明显的改善左心舒张功能的作用。     

Diagnosis of left ventricular diastolic dysfunction by Doppler echocardiography

Left ventricular(LV) diastolic dysfunction with preserved LV systolic function is common among patients with hypertension, especially with LV hypertrophy. Doppler echocardiography is one of the most useful clinical tools for the evaluation of diastolic function. Mitral inflow and pulmonary venous flow velocities are used not only for the assessment of diastolic function but also for predicting prognosis. Recently, tissue Doppler echocardiography has been also applied to evaluate diastolic function. Accurate assessment of diastolic function has been demonstrated by measuring both mitral annulus and mitral inflow velocity. In this article, We review the diagnosis of diastolic dysfunction by Doppler echocardiography using mitral inflow velocity, pulmonary venous flow velocity and mitral annulus velocity measured by tissue Doppler imaging.     

阿托伐他汀对高血压患者左心室肥厚的影响

目的 研究阿托伐他汀对高血压合并左心室肥厚的影响.方法 选择2008年1月至2009年6月,在我科门诊就诊的无脂代谢异常的高血压合并左心室肥厚患者56例,随机分为阿托伐他汀组和对照组.两组均常规给予厄贝沙坦150 mg,口服每天1次.阿托伐他汀组在常规用药基础上加用阿托伐他汀10 mg,口服每天1次.比较治疗6个月后心脏超声检查两组患者的左心室质量指数(LVMI).结果 两组患者的24小时平均收缩压(SBP)、平均舒张压(DBP)和LVMI在治疗6个月后均有所降低,治疗组24小时平均SBP(158.4±13.0)mmHg vs(124.5±7.8)mmHg(P<0.01),对照组24小时平均SBP(158.8±12.1)mmHg vs(125.3±9.1)mmHg(P<0.01);治疗组24小时平均DBP(109.7±11.0)mmHg vs(78.8±6.9)mmHg(P<0.01),对照组24小时平均DBP(106.2±13.6)mmHg vs(79.4±6.1)mmHg(P<0.01);治疗组LVMI(155±20)g/m2vs(138±10)g/m2(P<0.01),对照组LVMI(151±22)g/m2vs(141±12)g/m2(P<0.01).与对照组相比,阿托伐他汀组的LVMI降低更多(P<0.05).结论 在常规治疗基础上加用阿托伐他汀,更有助于降低高血压合并左心室肥厚患者的LVMI.     

体质量指数与左心室舒张功能不全的关系

目的:研究体质量指数异常与左心室舒张功能不全的关系。方法:收集行心脏超声检查且资料较完整的患者297人,按BMI水平,分为体质量正常组(119例)、超重组(94例)、肥胖组(84例)3组;探讨BMI各组与左心室舒张功能各项指标的相关性。结果:超重组的E/A平均值较正常组的E/A平均值低(Z=-0.243,P<0.001),肥胖组的E/A平均值较正常组的E/A平均值低(Z=-0.429,P<0.001),肥胖组的E/A平均值较超重组的E/A平均值低(Z=-0.186,P<0.001),各组间比较时P<0.001,统计学上有意义。左心室质量指数(LVWI)与BMI呈线性正相关,LVWI随着BMI升高而增大;E/A与BMI呈线性负相关,E/A值随着BMI增加渐渐降低。Logistic回归分析表明:年龄、性别、BMI、LVWI与左心室舒张功能不全相关;BMI越高,左心室舒张功能不全的风险越大;BMI对E/A的影响最大,其次为LVWI。高血压组E/A平均值比正常血压组低0.085,P<0.01,高血压是影响E/A值的因素。结论:BMI与左心室舒张功能不全具有独立相关性;随着BMI的升高,左心室舒张功能不全发生率增加。     

Hemodynamic effects of fenofibrate and coenzyme Q10 in type 2 diabetic subjects with left ventricular diastolic dysfunction

OBJECTIVE—To investigate the effects of fenofibrate and coenzyme Q₁₀ (CoQ) on diastolic function, ambulatory blood pressure (ABP), and heart rate (HR) in type 2 diabetic subjects with left ventricular diastolic dysfunction (LVDD).RESEARCH DESIGN AND METHODS—We randomized, double-blind, 74 subjects to fenofibrate 160 mg daily, CoQ 200 mg daily, fenofibrate 160 mg plus CoQ 200 mg daily, or matching placebo for 6 months. Echocardiography (including tissue Doppler imaging) and 24-h ABP and HR monitoring were performed pre- and postintervention.RESULTS—Neither fenofibrate nor CoQ, alone or in combination, altered early diastolic mitral annular myocardial relaxation velocity (E′), early-to-late mitral inflow velocity ratio (E/A), deceleration time, isovolumic relaxation time, or the ratio of early mitral flow velocity to early diastolic mitral annular myocardial relaxation velocity (E/E′) compared with placebo (P > 0.05). Fenofibrate and CoQ interactively (P = 0.001) lowered 24-h systolic blood pressure (−3.4 ± 0.09 mmHg, P = 0.010), with a prominent nocturnal effect (−5.7 ± 1.5 mmHg, P = 0.006). Fenofibrate (−1.3 ± 0.5 mmHg, P = 0.013) and CoQ (−2.2 ± 0.5 mmHg, P < 0.001) independently lowered 24-h diastolic blood pressure. Fenofibrate reduced 24-h HR (−3.3 ± 0.5 beats/min, P < 0.001), but CoQ had no effect on HR.CONCLUSIONS—In type 2 diabetic subjects with LVDD, neither fenofibrate nor CoQ, alone or in combination, improved diastolic function significantly. However, fenofibrate and CoQ independently and interactively lowered 24-h blood pressure, and fenofibrate alone reduced 24-h HR.The increased risk of cardiac failure in diabetes reflects not only coexistent coronary artery disease and hypertension, but also a specific diabetic cardiomyopathy (DCM) (1). Multiple mechanisms underlie DCM, including altered substrate utilization and energetics, oxidative stress, endothelial dysfunction, myocardial fibrosis, and myocyte apoptosis. DCM can manifest as impaired relaxation and increased stiffness of the myocardium (2), detectable preclinically by echocardiography as left ventricular diastolic dysfunction (LVDD). Therapies targeting hypertension, dyslipidemia, and hyperglycemia, as well as the specific mechanisms underlying DCM, may prevent progression of LVDD to overt cardiac failure.Fenofibrate, a peroxisome proliferator–activated receptor (PPAR)-α agonist, lowers triglycerides and raises HDL cholesterol. It could improve LVDD in diabetes by reducing myocardial free fatty acid and triglyceride delivery, thereby decreasing formation of lipid intermediates and oxidant species that promote myocyte apoptosis and fibrosis (1). However, in experimental animal models, PPAR-α overstimulation can promote fatty acid oxidation, leading to inefficient myocardial bioenergetics and pathologic remodeling (3). Importantly, there is no evidence for this in humans treated with fibrates (4), and in clinical trials in type 2 diabetes, fenofibrate reduced angiographic progression of coronary atherosclerosis (5) and microangiopathy (6), improved endothelial dysfunction (7), and modestly lowered blood pressure (BP) (6). Despite these effects, fenofibrate did not significantly decrease coronary events, the primary end point, in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study (6), but it did reduce total cardiovascular events.Coenzyme Q₁₀ (CoQ), a key intermediary in mitochondrial electron transport, has potent antioxidant properties. CoQ supplementation could improve LVDD by increasing myocardial energy production and decreasing oxidative stress, actions complementary to fenofibrate. CoQ improves endothelial function in type 2 diabetes (8), with modest beneficial effects on BP (9) and left ventricular (LV) systolic function (10).We previously showed that fenofibrate and CoQ synergistically improve microcirculatory function in type 2 diabetes (11). By targeting several mechanisms underlying LVDD in type 2 diabetes, we hypothesized that these treatments would improve cardiac function. Although fenofibrate and CoQ may lower clinic blood pressure (CBP), their effect on diurnal BP has not been investigated. Our secondary hypothesis was that these treatments would independently and interactively lower ambulatory blood pressure (ABP) and, by improving cardiac function, also lower heart rate (HR).     

缬沙坦对高血压患者左心室舒张功能的影响

目的探讨缬沙坦对高血压患者左心室舒张功能的影响。方法采用自身对照开放试验方法,48例原发性高血压伴左心室舒张功能不全的患者口服缬沙坦80～160mg,1次/d,治疗8周。对治疗前后进行超声多普勒左心功能测量与对照分析。结果与治疗前相比,48例高血压患者治疗8周后,血压显著下降(P<0.01);超声多普勒对照检查显示,心肌重量指数(LVMI)、左心室后壁舒张末期厚度(LVPWT)、室间隔舒张末期厚度(IVST)以及峰值充盈速度A、峰值速度A/峰值速度E比值均明显下降(P<0.01)。结论缬沙坦在降压的同时,能逆转左心室肥厚,有效地改善左心室舒张功能。