Prevalence and factors associated with left ventricular remodeling in renal artery stenosis

The objective of this study is to evaluate the prevalence, geometric patterns, and factors associated with left ventricular remodeling in patients with renal artery stenosis (RAS). Demographic, clinical, and echocardiographic data were assessed in 77 patients with RAS prior to endovascular stenting. The left ventricular mass index (LVMI) and relative wall thickness were calculated using American Society of Echocardiography (ASE) recommendations. Patients were classified based on LVMI and relative wall thickness into four ventricular remodeling patterns: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Logistic regression was done to investigate the determinants of the different ventricular remodeling patterns. Mean LVMI and relative wall thickness were 118 ± 40 g/m² and 0.45 ± 0.1. Left ventricular hypertrophy was observed in 65%. CH was the most prevalent geometric pattern of remodeling (normal, 16.9%; CR, 18.2%; CH, 40%; EH, 24.6%). Thirty (39%) patients had an abnormal LV systolic function (ejection fraction <55%), with 14 (46%) of them having eccentric hypertrophy. Independent predictor of EH was glomerular filtration rate (odds ratio [OR], 0.943; confidence interval [CI], 0.899–0.989; P = .01). Systolic elevation of blood pressure (OR, 1.030; CI, 1.003–1.058; P = .03) was associated with CH, and elevated diastolic blood pressure was associated with CR (OR, 0.927; CI, 0.867–0.992; P = .02). Patients with RAS have a high prevalence of left ventricular remodeling and LVH. Even though CH was the most prevalent pattern of left ventricular remodeling, EH was commonplace and was associated with renal dysfunction and heart failure.     

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.     

Relationship between left ventricular geometric pattern and systolic and diastolic function in treated Nigerian hypertensives

Introduction

Despite a high worldwide prevalence of left ventricular hypertrophy among black patients, the association of a specific left ventricular geometric pattern with left ventricular dysfunction is rare. The aim of this study was to explore the possibility of such an association in Nigerian hypertensives.

Methods

This was a retrospective study consisting of 188 treated hypertensives. Echocardiography was used to allocate the patients to the following four groups: normal geometric pattern, concentric remodelling, eccentric hypertrophy and concentric hypertrophy.

Results

The mean age of the study population was 55.95 ± 10.71 years. There were 75 females (39.9%). Concentric hypertrophy occurred in 72 (38.3%) patients and concentric remodelling in 53 (28.2%). Only 30 (16%) had a normal left ventricular geometric pattern. Hypertensive subjects with eccentric hypertrophy had the lowest ejection fraction, fractional fibre shortening and left ventricular ejection time but these did not reach statistical significance. The mean left atrial dimension was highest in the subjects with eccentric hypertrophy.

Conclusion

In this study population of treated Nigerian hypertensives, concentric remodelling and hypertrophy were the predominant left ventricular geometrical patterns.     

心率变异性与高血压左室重构关系的研究

目的：心率变异性（ＨＲＶ）分析是反映心脏自主神经活动的一项无创性指标。方法：研究ＨＲＶ在高血压左室重构中的作用,应用ＨＲＶ时域与频域分析法,检测与分析７０例高血压病（ＥＨ）男性患者２４小时ＲＲ间期标准差（ＳＤＮＮ）、心率变异指数（ＨＲＶＩ）及心率功率谱密度（ＰＳＤ）;并采用超声心动图测定相对室壁厚度（ＲＷＴ）与左室重量指数（ＬＶＭＩ）对患者进行左室构型分类。３０例健康男性被同期检测,以作对照。结果：７０ 例ＥＨ 患者被分为正常构型（ＲＷＴ 与ＬＶＭＩ均正常）,向心性重构（ＲＷＴ 增加,但ＬＶＭＩ正常）,向心性肥厚（ＲＷＴ与ＬＶＭＩ均增加）及离心性肥厚（ＲＷＴ正常,但ＬＶＭＩ增加）四个左室构型组。四组患者ＳＤＮＮ、ＨＲＶＩ、ＰＳＤ的低频（ＬＦ）峰值及其与高频（ＨＦ）峰值之比（ＬＦ／ＨＦ）均较正常人减低,而ＰＳＤ的ＨＦ峰值却均较正常人增高,该ＨＲＶ 变化特征的显著性依上述左室构型顺序呈现进行性增强。结论：交感与副交感神经的双重损害参与了高血压的左室重构机制,且其损害程度可能伴随左室重构过程的进行而加重     

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/m² vs. Group T 106.54 ± 27.95 g/m², 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.     

Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension

To evaluate the value of modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy (LVH) for patients with essential hypertension. A total of 381 patients with essential hypertension diagnosed in our hospital were selected. Using the left ventricle (LV) geometric patterns classified by the American Society of Echocardiography (ASE), we examined the distribution of the modified Cornell criteria of Ravl + S_D (the deepest S wave in 12‐lead ECG) in different geometric patterns and analyzed the correlation of modified Cornell criteria with changes in the LV geometric patterns using multiple linear regression analysis. The distribution of modified Cornell criteria, Sokolow‐Lyon criteria (RV5/V6 + SV1), and Cornell criteria (Ravl + SV3) in gender‐specific hypertensive geometric patterns were significantly different (P ≤ .01 for all). The voltage of Ravl + S_D in male patients showed an increase trend in the normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups, and this increase trend was significantly in the unadjusted model and the adjusted model. The voltages of Ravl + SV3 and RV5/V6 + SV1 of male patients in CR, CH and RH groups showed a gradual increase trend, but the increase trend in CR group has no statistical significance compared to that in NG group (P ≥ .05). The voltages of Ravl + S_D, RV5/V6 + SV1, and Ravl + SV3 in female patients in CR, CH and EH groups showed a trend of increase after decrease in the adjusted model. In conclusion, the modified Cornell criteria could dynamically reflect left ventricular hypertensive geometry of male patients.     

Left ventricular geometry as an independent predictor for extracardiac target organ damage in essential hypertension

Left ventricular hypertrophy (LVH) is an independent cardiovascular risk factor. It has not been established, however, whether left ventricular geometry is an independent predictor of extracardiac target organ damage in essential hypertension. Study groups were classified according to relative wall thickness: 27 patients with concentric LVH and 50 patients with eccentric LVH. Age and left ventricular mass indexes of two groups were matched. As indexes of extracardiac target organ damage, retinal funduscopic grade, and serum creatinine level were measured. The severity of hypertensive retinopathy and the renal involvement were more severe in patients with concentric LVH than in patients with eccentric LVH. Extracardiac target organ damage was consistently higher in patients with concentric LVH than in those with eccentric LVH. Systemic hemodynamics paralleled ventricular geometric patterns, with higher peripheral resistance and lower aortic compliance in patients with concentric LVH, whereas end-diastolic volumes and stroke volumes were higher in patients with eccentric LVH than in patients with concentric LVH. In addition, total peripheral resistance was related to retinal fundoscopic grade (r = 0.41, P < .01), and serum creatinine level (r = 0.28, P < .05). Even in the presence of an identical degree of LVH, echocardiographically determined left ventricular geometry may provide a further independent stratification of extracardiac target organ damage in essential hypertension.     

高血压患者不同左室构型的肺静脉血流比较

用脉冲多普勒超声评价不同左室构型高血压患者的肺静脉血流频谱.材料和方法:对110例单纯高血压患者(男81例,女29例),进行二维和脉冲多普勒超声检查,根据左室重量及相对室壁厚度分成四种不同构型,比较四组间肺静脉血流频谱特点.结果:110例高血压患者中构型正常者占55.45%(61例),向心性重构者占21.82%(24例),向心性肥厚者占10%(11例),偏心性肥厚者占12.73%(14例).肺静脉血流频谱示向心性肥厚组及偏心性肥厚组的VTIs、VTIs/(VTIs+VTId)较正常组及向心性重构组低(P<0.05),ARD增大,ARD/AD延长(P<0.005).结论:左室不同构型的高血压患者肺静脉血流频谱不同,提示向心性肥厚组及偏心性肥厚组左室舒张功能的损害较向心性重构组更明显.     

心电图电压指标与老年高血压患者心肌几何形态的临床分析

目的观察心电图各项电压指标对老年高血压患者心肌肥厚以及心肌肥厚不同几何形态的诊断价值。方法选择入住本院及门诊老年高血压患者86例,根据心脏超声检查结果,将患者分为4组:正常几何形态组(N组,28例)、向心性重构组(CR组,11例)、向心性肥厚组(CH组,25例)和离心性肥厚组(EH,22例)。观察各项心电图电压指标的阳性率。结果各种心电图电压指标均能明显区分正常及异常心脏几何形态,而12导联中,各导联QRS高度之和175 mm和ⅠR+S12 mm在CR组(63.6%、54.5%)和CH组(56.0%、72.0%)中的阳性率明显高于EH组(36.4%、31.8%,P0.05);继发性ST-T改变,CR组(72.7%)和CH组(80.0%)的阳性率明显高于EH组(45.5%,P0.05)。结论心电图电压指标12导联电压之和175 mm和Ⅰ R+S12 mm以及继发性ST-T改变可较好鉴别高血压不同类型心肌肥厚。     

Prevalence of left ventricular hypertrophy in a hypertensive population

AIMS: This investigation was set up to study the prevalence of leftventricular hypertrophy in a hypertensive population with referenceto a normotensive control group. From the general population3498 men and women aged 35, 45, 55 and 65 years old were invitedto a health examination. Participants with blood pressure above160 mmHg systolic or 95 mmHg diastolic or those taking antihypertensivemedication or having done so during the previous 6 months wereasked to undergo an echocardiographic examination. Normotensivecontrols were randomly selected from the same population. Of552 participants in the final study population, 194 were normotensivecontrols and 358 were in the hypertensive group. Echocardiographicmeasurements were made according to the Penn conventions andindexed for body surface. Cut-off values for left ventricularhypertrophy were 134 g. m^{– 2} for males and 102 g. m^–2 for women. RESULTS: Overall, the prevalence of left ventricular hypertrophy wasl4%/20% (men/women) in normotensives and 25%/26% in hypertensives(P<0·01). After subdivision by age and sex, therewas a significant difference in the prevalence of left ventricularhypertrophy between normotensives and hypertensives only inthe 65-year-old group (P<0·02 for males and P<0·05for females). CONCLUSION: The association between blood pressure and left ventricularhypertrophy in the general population is weak. Left ventricularhypertrophy is only significantly more frequent among hypertensivesas compared to normotensives in older people.     

N-terminal atrial natriuretic peptide and left ventricular geometry and function in a population sample of elderly males

OBJECTIVES: To investigate the relationships between N-terminal atrial natriuretic peptide (N-ANP) and left ventricular geometry and function. DESIGN: A cross-sectional study of a population-based cohort. SETTING: Follow-up of a health survey in Uppsala county, Sweden. SUBJECTS: Two hundred and five men aged 70. MAIN OUTCOME MEASURES: A Delfia sandwich immunoassay was used to measure the plasma levels of N-ANP. M-mode and Doppler echocardiographic examinations were used to measure left ventricular dimensions, mass, geometry and systolic function and to classify the subjects into four groups (normal geometry, concentric remodelling, concentric hypertrophy or eccentric hypertrophy). Left ventricular systolic dysfunction was defined as a left ventricular ejection fraction 相似文献   

超声观察高血压左室重构的临床意义

应用心脏超声按Ganau法对82例高血压患者的左室重构进行观察。结果显示:正常构形36例（占44％）;向心性重构6例（7％）;向心性肥厚11例（14％）和偏心性肥厚29例（35％）。     

Cardiac anatomy, function and metabolism in elite cyclists assessed by magnetic resonance imaging and spectroscopy

We investigated whether left ventricular hypertrophy in elitecyclists is associated with functional changes or abnormal energymetabolism. Left ventricular hypertrophy is a powerful risk factor for suddencardiac death with different prognostic significance among thevarious geometric forms. Cyclists may have a combination ofmixed eccentric and concentric hypertrophy. Magnetic resonance imaging was used to define left ventricularmass, geometry and function. Thirteen highly trained male cyclistsand 12 healthy controls were investigated. Proton-decoupledphosphorus-31 cardiac spectroscopy was performed to assess parametersof myocardial high-energy phosphate metabolism. Left ventricularmass and end-diastolic volumes normalized for body surface areawere significantly higher in cyclists (124·1 ±9·4 g. m^–2 and 106·2 ± 11·4ml. m^–2, respectively) than in controls (85·9 ±9·3 g. m^–2 and 79·1 ± 11·6ml. m^–2, respectively), (both P<0·0001). Theleft ventricular mass to end-diastolic volume ratio, as a parameterof left ventricular geometry, was not significantly increasedin cyclists compared to controls. Resting left ventricular ejectionfraction, cardiac index, and systolic wall stress in cyclistsdid not differ significantly from those of controls. The phosphocreatineto adenosine triphosphate ratio was not significantly differentbetween cyclists and controls (2·2 ± 0·34vs 2·2 ± 0·17, ns). Cyclists show prominent left ventricular hypertrophy with normalgeometry. The finding that the hypertrophic hearts of the cyclistshad normal left ventricular function and a normal phosphocreatineto adenosine triphosphate ratio suggests that sport-inducedleft ventricular hypertrophy is a physiological adaptation ratherthan a pathophysiological response.     

Concentric left ventricular remodeling and aortic stiffness: A comparison of obesity and hypertension

Background

Increased thoracic ascending aortic stiffness is thought to contribute to concentric left ventricular hypertrophy and increased mortality, a pattern seen in hypertension. As such, aortic stiffness and increased left ventricular mass are candidates by which obesity increases cardiovascular risk. However, obesity is characterized predominantly by increased abdominal aortic stiffness and with eccentric left ventricular hypertrophy.

Methods

We aimed to establish whether or not, in addition to these changes, there is also an element of concentric remodeling in obesity that was predicted by ascending aortic stiffness. 301 subjects underwent cardiovascular magnetic resonance imaging to measure regional aortic distensibility and left ventricular morphology. To compare obesity with hypertension, subjects were separated into groups by hypertensive status and body mass index.

Results

In comparison to normotensive subjects, hypertension was linked with concentric remodeling (a 17% increase in left ventricular mass:volume ratio (LVM:VR), (p < 0.001)) and reduced ascending aortic distensibility (by 64%,p < 0.001). LVM:VR was negatively correlated with ascending aortic distensibility (R = − 0.36,p < 0.01). Obesity, in the absence of hypertension, was associated with elevated left ventricular mass when compared to normal weight normotensive subjects (by 27%, p < 0.01), in an eccentric pattern with cavity dilatation (p < 0.01). However, LVM:VR was also 14% larger than in normal weight normotensive subjects (p < 0.01), indicative of additional concentric remodeling. LVM:VR in obesity was, however, not correlated with ascending aortic distensibility when adjusted for mean arterial pressure (R = − 0.14,p < 0.14).

Conclusion

In summary, despite the predominantly eccentric pattern of left hypertrophy in obesity there is a concentric element of hypertrophy that, unlike in hypertension, is not linked to increased ascending aortic stiffness.     

Left ventricular wall thickness and plasma catecholamines in borderline and stable essential hypertension

It has been suggested that sympathetic overactivity has a pathogeneticrelevance to left ventricular hypertrophic development, evenapart from its effect on and in essential hypertension. To evaluate this possibility by echocardiographic and polygraphicmethods, we studied left ventricular wall thickness and functionand their possible relationship to plasma renin activity andplasma catecholamines in 11 normal subjects, 13 borderline hypertensivesand 11 stable hypertensives without radiological or electrocardiographicsigns of left ventricular hypertrophy. Compared with normal, borderline hypertensives showed an increasein interventricular septum (IVS) thickness (P < 0.01) andIVS/posterior wall (PW) thickness ratio (P < 0.01) togetherwith an increased supine and upright plasma norepinephrine (NE;P < 0.01); there was also a decreased pre-ejection period(PEP; P < 0.01), PEP/left ventricular ejection time ratio(P < 0.01) and total electromechanical systole (P < 0.05). In stable hypertensives, PW thickness was greater than it wasboth in normals (P < 0.01) and in borderline hypertensives(P < 0.01) and IVS thickness was higher than in normals (P< 0.05). Positive correlations between supine (P < 0.001), upright(P < 0.05) NE and both IVS thickness and IVS/PW thicknessratio were found in borderline but not in stable hypertensives. These results support the hypothesis recently put forward thatIVS hypertrophy may represent an early stage of essential hypertension-inducedLVH, which afterwards extends to the left PW; furthermore theresults suggest that the sympathetic overactivity may play arole in the IVS hypertrophy development in borderline hypertensives.     

Effects of respiration on left ventricular diastolic function in healthy children

Pulsed Doppler echocardiographic indices of mitral valve fillingwere measured in 20 healthy children, between 3 and 125 yearsold, in order to evaluate the effects of spontaneous respirationon left ventricular diastolic filling patterns. There were significantrespiratory variations in four parameters of left ventriculardiastolic function: The peak early filling velocity, the ratioof early to late peak filling velocity, and the ratio of earlyto late diastolic velocity-time integral decreased significantlyduring inspiration (mean decrease 7%, P<0·05; 16%,P<0·01; and 12%, P<0·05, respectively).On the other hand there was a significant increase in late peakfilling velocity with inspiration (10% increase, P<0·05).Other variables of left ventricular diastolic filling were unchangedwith inspiration. These results suggest that assessment of leftventricular diastolic function in children should be standardizedwith regard to respiratory phases in any clinical application. (Eur Heart J 1996; 17: 453%456)     

The Relationship Between High‐Sensitivity C‐Reactive Protein Levels and Left Ventricular Hypertrophy in Patients With Newly Diagnosed Hypertension

The authors aimed to evaluate the relationship between high‐sensitivity C‐reactive protein (hs‐CRP) and presence of left ventricular hypertrophy and diastolic dysfunction in patients with hypertension. A total of 95 newly diagnosed hypertensive patients (mean age, 54±10 years) and 20 controls were included in this study. Patients were divided into four groups according to relative wall thickness as normal, concentric remodeling, concentric, and eccentric hypertrophy. hs‐CRP was measured in all patients and serum hs‐CRP level was shown to be increased in patients with hypertension compared with controls (0.57 mg/dL vs 0.25 mg/dL, respectively; P<.001). The hs‐CRP level was highest in patients with concentric hypertrophy. When compared with controls, serum hs‐CRP level was significantly higher in patients with concentric remodeling (0.61±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.030) and concentric hypertrophy (0.69±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.032). The present study shows that serum hs‐CRP is significantly associated with left ventricular diastolic function and concentric hypertrophy in patients with hypertension.     

Left ventricular systolic function after marked reduction of ventricular hypertrophy induced by 5 years' enalapril treatment

OBJECTIVES: To determine the effects of long-term treatment of essentialhypertension with an angiotensin-converting enzyme inhibitoras regards arterial pressure at rest and during exercise, leftventricular mass and functional sequelae. PATIENTS AND METHODS: Twenty-six patients with previously untreated essential hypertensiontook enalapril 20 mg twice daily for 5 years. Cardiovascularparameters were determined by two-dimensionally guided M-modeechocardiography in a pre-treatment placebo phase, 8 weeks and1, 3 and 5 years after the start of therapy, and 8 weeks afterdrugs were discontinued. RESULTS: Therapy reduced resting arterial pressure from 156/105 to 128/84mmHg (P<0.001) and arterial pressure during exercise from205/113 to 172/94 mmHg (P<0.0011). After 1, 3 and 5 years'therapy, left ventricular mass index had decreased by 15, 28and 39% respectively (P<0.001 in each case). Eight weeksafter treatment was halted, arterial pressure at rest and duringexercise had returned to pre-treatment values, but decreasedleft ventricular mass was maintained Left ventricular pump functionhad improved after 5 years' treatment, and this improvementwas maintained during the 8 weeks without treatment. CONCLUSIONS: Significant reductions in arterial pressure at rest and duringexercise were achieved by 8 weeks' treatment with enalapriland maintained during 5 years' further treatment, while a markedreduction in left ventricular mass took place progressivelythroughout the 5 year period. Reduction of myocardial hypertrophyby enalapril appeared to be beneficial rather than detrimentalto cardiac pump performance.     

原发性高血压患者左心室功能的临床研究

目的探讨原发性高血压患者左心室功能的临床研究。方法原发性高血压患者176例,按Ganau法分为4型:正常构型组(A组)46例、向心性重构组(B组)53例、向心性肥厚组(C组)40例、离心性肥厚组(D组)37例;正常对照组35例。超声心动图测量舒张末室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径,二尖瓣血流频谱左心室舒张早期血流峰速(E),舒张晚期血流峰速(A)值比,左心室射血分数(LVEF)及Tei指数。各组血浆脑钠肽(BNP)浓度对比分析。结果正常对照组与高血压各组比较,在年龄、性别均差异无显著性意义,C组、D组收缩压最高,左心房内径最大(P<0.05);B组、D组IVS、LVPW轻度增厚(P<0.05);高血压各组的E/A值均降低(P<0.05),LVEF值只有D组与正常对照组比较差异有显著性意义;各组Tei指数差异有显著性意义;BNP在B组、C组、D组差异有显著性意义。结论Tei指数,BNP共同评价原发性高血压患者不同左心室构型的心功能情况,对原发性高血压的治疗效果和预后有临床应用价值。     

Left ventricular structural and functional characteristics in patients with renovascular hypertension,primary aldosteronism and essential hypertension

To investigate the effect of different etiologies of hypertension on left ventricular structure and function, we compared echocardiographic findings in 10 patients with renovascular hypertension (35 ± 9 years), 10 patients with primary aldosteronism (42 ± 9 years), and 14 patients with essential hypertension (41 ± 6 years). There were no significant differences among the three groups in age, sex, body surface area, blood pressure, interventricular septal thickness, posterior wall thickness, left ventricular end-diastolic dimension or end-systolic dimension, relative wall thickness, left ventricular mass index, or spectrum of left ventricular adaptation (concentric remodeling, concentric hypertrophy, or eccentric hypertrophy). There were no differences in systolic function or diastolic function, which was assessed in terms of the peak rate of increase in dimension normalized for left ventricular end-diastolic dimension (dD/dt/D), the relaxation time, and the relaxation time to peak velocity of lengthening among groups. Multiple regression analysis showed that the systolic blood pressure was the most important determinant of left ventricular mass index (r = 0.56, P < .01), and that left ventricular mass index was the most important determinant of relaxation time and the relaxation time to peak velocity of lengthening (r = 0.48, P < .01 and r = 0.59, P < .01, respectively). The dD/dt/D was correlated only with left ventricular end-systolic dimension (r = 0.59, P < .01). Our results suggest that blood pressure may be a strong determinant of left ventricular hypertrophy, irrespective of the etiology of hypertension, and that the degree of hypertrophy may be related to left ventricular diastolic dysfunction in hypertensive patients with normal systolic function.