原发性高血压左心室不同构型民律失常的比较

目的 研究原发性高血压患者左心室重构不同构型间心律失常的差异。方法 179例原发性高血压患者均进行了24h动态心电图，动态血压监测，超声心动图等检查，根据检查结果划分左心室构型，判定心律失常，比较左心室重构组与正常构型组心律失常的发生率；通过多元逐步回归分析，甄选出对心律失常有独立影响的因素。并在校正这些影响因素后，比较左心室不同构型间心律失常严重程度的差异。结果 左心室重构组的房性心律失常，室性心律失常，复杂室性心律失常的发生率均显著高于正常构型组，而影响原发性高血压心律失常的相对独立因素很多，其中部分左心室解剖结构指标，高血压分级，左心房内径，E/A值，夜间舒张压负荷值以及日平均心率等占重要地位；校正上述影响因素后，不同构型两两比较时，部分构型之间心律失常分级级别仍存在差异，且差异为构型本知差异所致。结论 原发性高血压心律失常的影响因素很多（例如高血压分级、左心室重量指数，左心房内径，左心室后壁厚度等），不同构型间心律失常的严重程度存在差异。     

原发性高血压左心室不同构型心律失常的比较

目的研究原发性高血压患者左心室重构不同构型间心律失常的差异.方法179例原发性高血压患者均进行了24 h动态心电图、动态血压监测、超声心动图等检查,根据检查结果划分左心室构型、判定心律失常,比较左心室重构组与正常构型组心律失常的发生率;通过多元逐步回归分析,甄选出对心律失常有独立影响的因素,并在校正这些影响因素后,比较左心室不同构型间心律失常严重程度的差异.结果左心室重构组的房性心律失常、室性心律失常、复杂室性心律失常的发生率均显著高于正常构型组.而影响原发性高血压心律失常的相对独立因素很多,其中部分左心室解剖结构指标、高血压分级、左心房内径、E/A值、夜间舒张压负荷值以及日平均心率等占重要地位;校正上述影响因素后,不同构型两两比较时,部分构型之间心律失常分级级别仍存在差异,且差异为构型本身差异所致.结论原发性高血压心律失常的影响因素很多(例如高血压分级、左心室重量指数、左心房内径、左心室后壁厚度等),不同构型间心律失常的严重程度存在差异.     

Relation between P-wave dispersion and left ventricular geometric patterns in newly diagnosed essential hypertension

Aim

P-wave durations and P-wave dispersion (PD) are considered to reflect the heterogeneous conduction in atria. The aim of this study was to investigate PD and P-wave duration in different left ventricle geometric patterns of hypertensive patients.

Methods

One hundred forty-nine consecutive patients with newly diagnosed essential hypertension and 29 healthy control groups were included in the study. The maximum and minimum P-wave duration (P_max and P_min, respectively) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed in all subjects. Four different geometric patterns were identified in hypertensive patients according to left ventricular mass index (LVMI) and relative wall thickness.

Results

P-wave dispersion was longer in concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups when compared with the control group (P = .009, P < .001, P < .001, respectively). P-wave dispersion of normal left ventricle (NLV) geometric pattern was not different from that of the control group. Patients with NLV geometric pattern had shorter PD than patients who had CH and EH (NLV vs CH, P < .001; NLV vs EH, P = .025). P-wave dispersion of the NLV group was not different from that of the CR group. Patients with CR had also shorter PD than patients who had CH (P = .002). In bivariate analysis, there was a significant correlation between PD with left ventricle geometry, body surface area, LVMI, and relative wall thickness. In multiple linear regression analysis, PD was independently correlated only with LVMI (β = .425, P < .001).

Conclusions

P-wave dispersion is independently associated with LVMI rather than left ventricle geometry and relative wall thickness in hypertensive patients. Thus, it is increased particularly in patients with CH and EH.     

细胞因子与高血压病患者左室构型的相关性研究

目的观察高血压病患者细胞因子的变化及与左室构型改变的相关性。方法采用酶联免疫吸附测定法检测60例高血压病患者(高血压组)和20例正常对照组血清炎性细胞因子浓度,并应用彩色多普勒超声心动图测定其左心室重量指数(LVMI)、相对室壁厚度(RWT)分析左室构型改变与细胞因子相关性。结果与正常对照组比较,高血压组左室不同构型组的血清细胞因子含量明显升高,高血压组中正常构型组与其他构型组的血清细胞因子含量比较也有明显差异,高血压组LVMI与肿瘤坏死因子α(TNFα)、白细胞介素6呈正相关,RWT与TNFα呈正相关。结论细胞因子的过度激活与高血压病患者左室构型改变密切相关,在心肌重构发生发展中起着重要的作用。     

Relation of plasma brain and atrial natriuretic peptides to left ventricular geometric patterns in essential hypertension

We investigated whether plasma brain and atrial natriuretic peptide (BNP and ANP, respectively) levels could reflect left ventricular (LV) geometry and function in patients with mild to moderate essential hypertension. A positive correlation was found between LV mass index (LVMI) and plasma ANP levels in 84 untreated, hypertensive patients, but not between LVMI and plasma BNP levels. As compared with other geometric patterns, plasma BNP levels were increased in concentric hypertrophy, in which LVMI was increased and LV diastolic function was decreased. These data suggest that production of BNP was increased in hypertensive patients with concentric hypertrophy via LV overload or depression of diastolic function.     

Left ventricular geometric patterns and QT dispersion in untreated essential hypertension

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography.Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT.Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively).QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns.We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.     

定量组织速度成像技术评估高血压患者左室构型与功能关系的研究

目的应用QTVI超声心动技术评价高血压患者左室构型与功能的关系。方法120名原发性高血压患者按Ganau分类法分为4型,正常对照组32名,均行常规超声心动图及QTVI检查。比较分析QTVI所测左室壁二尖瓣环六个位点(侧壁和后间隔、前壁和下壁、前间隔和后壁)处的运动速度指标Sm、Em、Am及Em/Am的变化特点,且与常规超声心动功能指标FS、LVEF、E/A进行比较。结果①高血压各组患者左室壁二尖瓣环六个位点处的平均Sm、Em较正常对照组均显著减低(P<0.05或P<0.01);②Sm在高血压各组中数值呈递减变化,离心性肥厚组Sm最低;③在高血压各组中,向心性肥厚组Em数值最小,其次为离心性肥厚组,向心性重构组和正常构型组。结论①QTVI技术比常规超声心动图能更早、更敏感地发现高血压所致的左心室收缩、舒张功能障碍。②随着高血压时左室由正常构型向离心性肥厚的发展,QTVI能准确评估左心室收缩和舒张功能变化特点。     

Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension.

The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables). Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was super-normal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p less than 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload. Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.     

Cardiomyocyte functions couple with left ventricular geometric patterns in hypertension.

Previous studies have suggested the prognostic significance of left ventricular (LV) geometric patterns in essential hypertension. However, the relation between cardiomyocyte functional changes and LV geometric patterns has not been clarified. This study was designed to assess the morphological and functional changes in isolated myocytes derived from different LV geometric patterns in hypertension. After 2-3 weeks of a high-salt (8%) diet from the age of 6 weeks, 20 Dahl salt-sensitive (DS) rats were classified into the following three groups on the basis of an echocardiographically determined LV mass index and the relative wall thickness: concentric hypertrophy (11), eccentric hypertrophy (4), and concentric remodeling (5). Ten Dahl salt-resistant (DR) rats served as controls. In vivo LV functions were assessed based on echocardiographic measurements. We examined ventricular myocytes isolated from all groups. To evaluate the force-frequency relation, cardiomyocytes isolated from all groups were paced at stimulation rates of 0.3, 0.5, 1.0, 2.0, and 3.0 Hz. Concentric hypertrophy and eccentric hypertrophy groups exhibited an increase in myocyte width but no changes in the length. Concentric hypertrophy and concentric remodeling groups demonstrated in vivo LV dysfunction. In addition, DS rats, especially these with concentric hypertrophy, demonstrated impaired frequency responses in terms of both myocyte contraction and relaxation compared with DR rats. This impaired force-frequency relationship was especially remarkable at high frequencies. These findings suggest that the structural and functional changes in cardiomyocytes are closely related to the LV geometric pattern and may contribute to a different prognosis according to different geometric patterns.     

Relation of hemodynamic reaction during stress to left ventricular hypertrophy in essential hypertension

To elucidate the impact of increased afterload during physical and mental stress on myocardial hypertrophy, a homogeneous population of 73 patients with untreated mild-to-moderate essential hypertension were enrolled in the current study. Left ventricular mass and cross-sectional area, both determined by 2-D guided M-mode echocardiography, were related to blood pressure measured at rest as well as during various stress situations. Left ventricular mass and cross-sectional area correlated with systolic pressure at work site (r = 0.28 and r = 0.23 respectively, P less than .05) and systolic pressure at complete rest (r = 0.35 and r = 0.33, P less than .01). Neither the response in blood pressure to mental arithmetic or a bicycle exercise test performed in the laboratory, nor blood pressure during both stress tests were significantly related to the degree of left ventricular hypertrophy. In addition, patients with a hyperreactive response to mental arithmetic or to the physical stress test did not disclose a greater left ventricular mass than normoreactors. Examining the hemodynamic response pattern during mental arithmetic, we found that patients with vasoconstriction during mental stress had a greater left ventricular mass than individuals with vasodilation during mental stress (244 +/- 73 v 204 +/- 53 g, P less than .05), but this was due to the impact of obesity on left ventricular mass (analysis of covariance: F = 2.1, P = NS). Thus, blood pressure at work site and at rest, but not blood pressure during mental or physical stress, nor the response of blood pressure to both stress tests, was linked to the degree of left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)     

左心室质量及几何模式对左心室功能的影响

目的 探讨左心室质量(LVM)及几何模式对左心室功能的影响。方法 根据相对室壁厚度(RWT)>0.43和≤0.43将170例高血压患者分为向心性模式组和离心性模式组,分别作超声心动图检测。结果 向心性模式组的EF明显高于离心性模式组,而前者E、E/A明显低于后者。单变量及多变量回归分析均显示EF与LVM及RWT相关,E/A在单变量分析时与RWT呈非常显著负相关,但在多变量分析时被剔出。结论 LVM及几何模式的改变均对左心室收缩功能产生明显的损害,几何模式的变化可能对左心室舒张功能也会产生不利影响。     

Relationship between left ventricular diastolic function and geometric patterns in Nigerians with newly diagnosed systemic hypertension

Background

It is not known whether abnormalities of left ventricular diastolic function are influenced by the various cardiac geometric patterns in Nigerians with newly diagnosed systemic hypertension.

Objective

To evaluate the relationship between the parameters of left ventricular diastolic function and the geometric patterns in this group of patients.

Methods

Two-dimensional, guided M-mode echocardiography including Doppler was performed in 150 consecutive, newly diagnosed hypertensive individuals and normotensive controls aged between 35 and 74 years. Left ventricular mass index and relative wall thickness were used to classify the hypertensive individuals into four geometric patterns, and the pulsed-wave Doppler parameters obtained were used to categorise the abnormalities of diastolic function.

Results

Four left ventricular geometric patterns were identified: 23 (15.3%) had normal left ventricle geometry, 33 (22%) had concentric remodelling, 37 (24.7%) were found to have eccentric hypertrophy, and concentric hypertrophy occurred in 57 (38%) of the hypertensive individuals. Left ventricular diastolic dysfunction occurred more in hypertensives with concentric left ventricular geometric pattern. Increased left ventricular mass index and relative wall thickness were found to be associated with the mitral E-wave, E/A ratio and pulmonary venous flow S-wave in the hypertensives (p < 0.001).

Conclusion

In newly diagnosed Nigerian hypertensives, the abnormalities in left ventricular diastolic function varied between the different left ventricular geometric patterns, being worst in those with concentric geometry.     

Ventricular arrhythmias and left ventricular hypertrophy in essential hypertension

BACKGROUND: Patients with essential hypertension and/or left ventricular hypertrophy and ventricular arrhythmias suffer from an increased mortality rate. In all previous studies on hypertension, the criterion for inclusion was diastolic blood pressure > 95 mmHg. This is a low selective threshold. Our study attempted to evaluate the incidence of ventricular arrhythmia in hypertensive patients not receiving pharmacological treatment and diagnosed by 24-h ambulatory blood pressure monitoring (ABPM), therefore using a more selective criterion than WHO guidelines. METHODS: Hundred-twenty-height consecutive patients with hypertension diagnosed on the basis of WHO guidelines were screened for 24-h ambulatory blood pressure measurement. Eighty-five (66.4%) presented a 24-h mean blood pressure > 135/85 mmHg. All 85 patients were screened for M-mode, B-mode echocardiography, PW Doppler and 24-h ECG Holter recordings. RESULTS: Sixty patients (70.6%) were affected by left ventricular hypertrophy and 25 were free (29.4%). Thirty-six patients (42.4%) had left ventricular diastolic dysfunction, 49 were free (57.6%). According to Lown and Wolf's classification of ventricular arrhythmia, 20 patients (23.5%) presented Grade I arrhythmia, 5 (5.9%) presented Grade II, 4 (4.7%) Grade III, 9 (10.6%) Grade IVA, 20 (23.5%) Grade IVB, 12 (14.1%) Grade V and 15 patients (17.6%) were free from premature ventricular complexes, namely Grade 0 arrhythmia. Left ventricular hypertrophy was found to correlate significantly with the arrhythmia score, r = 0.552 for p < 0.0001. Moreover, left ventricular diastolic dysfunction correlated significantly with the arrhythmia score, r = 0.495 for p < 0.0001. There was also a good correlation between left ventricular hypertrophy and left ventricular diastolic dysfunction, r = 0.616 for p < 0.0001. Among patients affected by left ventricular diastolic dysfunction and left ventricular hypertrophy, the correlation with the arrhythmia score was even closer, r = 0.586 for p < 0.0007. CONCLUSIONS: We conclude that by using a more selective criterion for the diagnosis of hypertension, we can identify patients with a highly significant statistical correlation between left ventricular hypertrophy and ventricular arrhythmia score, and also between diastolic dysfunction and the ventricular arrhythmia score, due to a more severe stage of disease. It is useful to detect those patients affected by ventricular arrhythmias for the primary prevention of major cardiovascular events.     

Association between left ventricular diastolic dysfunction and renal hemodynamic change in patients with treated essential hypertension.

The heart and kidneys are important target organs in hypertension. Early signs of hypertensive target organ damage can be detected by evaluating left ventricular (LV) diastolic function and intrarenal hemodynamics using Doppler ultrasonography. However, it has not been sufficiently clarified whether cardiac damage and renal impairment progress in parallel, especially from the early stage. In the present study, Doppler echocardiography and renal Doppler ultrasonography were performed in 99 patients with treated essential hypertension, and LV diastolic filling parameters, ie., the velocity ratio of atrial filling to early diastolic filling (A/E), and the deceleration time of the E wave (DcT) and renal Doppler parameters, i.e., the diastolic to systolic ratio (D/S) and resistance index (RI), were determined. D/S was negatively correlated and RI was positively correlated with A/E and DcT. These cardiac and renal Doppler parameters were also associated with age, diastolic blood pressure, creatinine clearance, and/or glucose levels. By multiple regression analysis, D/S was found to have a significant association with DcT, independent of other clinical parameters, including age. In subgroup analysis in which patients were divided by their glucose tolerance, a significant correlation between renal Doppler parameters and LV diastolic function was observed in subjects with normal glucose tolerance, but this correlation disappeared in those with impaired glucose tolerance and diabetes mellitus. The present findings show that there is a significant relation between LV diastolic function and renal Doppler parameters in treated hypertensive patients, and suggest that cardiac damage progresses in parallel with renal involvement in these patients from the early stage.     

The relation between left ventricular geometric patterns and left ventricular midwall mechanics in hypertensive patients.

To evaluate the alteration of myocardial contractility in hypertensive patients with different left ventricular geometric patterns by the end-systolic stress-midwall fractional shortening relation. Echocardiography was applied to study the left ventricular geometry and cardiac function among 117 cases of essential hypertension, with 45 normal cases as control(s). Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated using echocardiographic data. All patients were divided into four kinds of left ventricular geometry pattern based on LVMI and RWT. Patients of the eccentric hypertrophy group suffered the most serious damage of left ventricular systolic function. Myocardial contractility shown by end-systolic stress-midwall fractional shortening relation was significantly decreased in the concentric remodeling group, eccentric hypertrophy group and concentric hypertrophy group, and those with concentric hypertrophy showed the worst contractility. The degree of myocardial contractility damage was different in patients with different left ventricular geometric patterns. Geometric changes may have compensated for the reduction of myocardial contractility in some phases in order to maintain the normal pump function.     

Hemodynamic hypertrophied left ventricular patterns in systemic hypertension

The hemodynamic pattern of hypertrophied left ventricle in systemic hypertension was studied by M-mode echocardiography in 42 untreated hypertensive patients with left ventricular (LV) mass index greater than 2 standard deviations from the sex-specific mean of 114 normal subjects (normal values of our laboratory), and in 45 normotensive volunteers. Hypertensive patients showed cardiac dimensions, relative diastolic wall thickness, ratio of systolic pressure to end-systolic dimension, cardiac index and stroke index greater than normotensive control subjects (0.01 less than p less than 0.0001). Pressure/dimension ratio was correlated to relative wall thickness (p less than 0.005). End-systolic stress/volume ratio was normal as was systolic pressure to dimension ratio normalized for end-diastolic wall thickness. LV hypertrophy was concentric in 26% and eccentric in 74% of patients and suggested 2 different heart adaptations to overload: eccentric hypertrophy was associated with increased cardiac dimensions, high peak stress, normal systolic function and moderately increased LV contractility; concentric hypertrophy was associated with the highest blood pressure values, normal cardiac dimension, normal peak stress, normal systolic function and much increased LV contractility. Because stress/volume ratio and wall thickness-corrected systolic pressure/dimension ratio were normal in hypertensive patients, LV contractile capacity might be supported by the increase in myocardium available for contraction, rather than by increase in inotropic state.     

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.     

Autonomic nervous system and left ventricular hypertrophy in essential hypertension

BACKGROUND: Patients with essential hypertension (EH) and left ventricular hypertrophy (LVH) have an increased risk of cardio-vascular complications. Alterations in the autonomic nervous system (ANS) activity may play a role in the development of serious cardiac arrhythmias and mortality in these patients. AIM: To examine the activity of ANS in patients with established EH in relation to the presence of LVH. METHODS: The study group consisted of 70 subjects: 50 patients with untreated EH (mean age 44.4+/-12.7 years, 28 patients without LVH and 22 with LVH), and 20 age-matched healthy volunteers. ANS reactivity was assessed using heart rate variability (HRV) analysed during tilt table testing at 60 degrees. The following 5-min time-periods were analysed: (A) before tilting (supine position), (B) initial period of tilting, (C) last 5 min of tilting, and (D) immediately after completion of tilt test (after return to supine position). RESULTS: Patients with EH without LVH had a higher increase of LF/HF values (period B versus period C) compared with controls (p<0.05). The change from tilt to supine position caused significantly lower change in lnHF values in patients with EH and LVH than in controls (p<0.01) or patients with EH without LVH (p<0.005). In patients with EH and LVH a significant correlation between HF and LVmass/height (r=-0.5, p<0.01) was noted. Compared with healthy controls, patients with EH and LVH had significantly lower HRV parameters [lnLF values were significantly lower in all analysed periods, (p<0.05), and lnHF - during period D, (p<0.01)] whereas LF/HF ratio assessed during period D was significantly higher (p<0.05). CONCLUSIONS: In patients with EH without LVH a relative dominance of sympathetic activity is present. LVH in EH leads to a decrease in vagal drive and progressive inhibition of parasympathetic activity, both of which decrease HRV. These changes may play an important role in the electrical instability of hypertrophied myocardium.     

高血压病对左室功能的影响

目的:探讨高血压病患者心脏左室功能的改变。 方法:应用超声心动图及组织多普勒显像(DTI)检测74例高血压病患者及94例正常对照者左室收缩及舒张功能。 结果:高血压病组左室质量指数、跨二尖瓣血流频谱速度A及E/A比值和DTI频谱速度s、a及e/a比值较正常组有显著差异(P<0.05),但左室射血分数(LVEF)、跨二尖瓣血流频谱速度E和DTI频谱速度e在高血压病组及正常组间无显著差异(P>0.05);DTI的收缩期峰速度与LVEF和舒张期峰速度比值e/a与E/A在两组间均呈显著相关(P<0.05)。 结论:高血压痛患者收缩期峰速度s及舒张晚期峰速度a增加,提示左室收缩功能增强,左室僵硬度增加,左房辅助泵功能增强;DTI能早期、敏感地发现高血压病患者收缩及舒张功能的改变。