高血压左室构型与左室中层力学的关系

目的:用室壁应力-左室中层缩短率关系做为评价心肌收缩性的指标,研究高血压不同左室构型患者心肌收缩性的改变与心功能变化的关系.方法:应用超声心动图计算左室重量指数(LVMI)和相对室壁厚度(RWT),按LVMI和RWT将左心室分为四种构型.对117例原发性高血压病人和45例健康人左心室结构按左室室壁应力(MESS)和室壁中层缩短率(mFS)来估计心功能情况.结果:以射血分数、左室短轴缩短率和左室中层缩短率表示的收缩功能离心性肥厚受损最重,以室壁应力-左室中层缩短率关系表示的心肌收缩性,向心性肥厚最重.以EF斜率等表示的心脏舒张功能高血压不同左室构型患者损害不同,舒张功能的改变与心肌收缩性的损害成正相关.结论:高血压不同左室构型患者心肌收缩性损害不同,左室构型向向心性发展在一定阶段上代偿了心肌收缩性的下降,以保持心脏收缩排血功能的正常.     

高血压左室肥厚的不同构型

高血压544例（男性336）和无高血压的配对组204例（男性106），应用心脏超声法对左室构型进行研究，依据相对室壁厚度、左室质量指数的分布、前室间隔及其基底部肥厚程度。6种左室构型检出率分别为:正常左室构型，男女分别占52％，42%；离心性肥厚占16％，25％，性别差异显著（P＜0.001）；向心性重构，男女各占10%，9％；向心性肥厚7％，8％；非对称性室间隔肥厚及前室间隔基底部肥厚型，分别占7%，9％。研究表明左室构型与年龄、性别、病程及收缩压有一定关系，但左室肥厚类型的形成可能取决于心脏内在因素，向心性肥厚与离心性肥厚之间不一定有依从关系。     

高血压左室构型与QT离散度的关系

本文观察了高血压病人左心室肥厚和不同左室构型与ＱＴ离散度 ,旨在探讨两者的关系。按 1978年ＷＨＯ高血压病的诊断标准随机选取了高血压病住院患者 94例 ,男 5 3例、女 41例 ,平均 5 5 .8(38～ 74)岁 ,高血压病程平均 9(4～15 )年。同时选正常人 15例做对照 ,男 9例、女 6例。所有病例均经体格检查和心脏超声心动图检查无瓣膜疾病和其它心脏疾病 ,排除继发性高血压 ,近期未用过抗心律失常药物。血清电解质均在正常范围。常规测量身高、体重、计算体表面积 (ＢＳＡ)。采用日本ＡＬＯＫＡ .ＳＳＤ——— 710型心脏超声诊断仪 ,探头频率 2 .5…     

脑钠肽与高血压左室重塑、左室功能的关系

该文探讨原发性高血压（EH）患者脑钠肽（BNP）水平与左室几何构型、左室功能的关系。方法：应用荧光免疫法快速测定EH组（106例）和对照组（46例）的血浆BNP浓度，根据心脏彩色超声检测结果，依照左室质量指数（LVMI）、相对室壁厚度（RWT）将106例EH患者分为：正常构型亚组（12例）、向心性重构亚组（9例）、离心性肥厚亚组（64例）、向心性肥厚亚组（21例）。     

高血压左室构型与心功能的关系

目的与方法本文采用二维和Ｍ型超声心动图方法,将２０９例高血压病人的左室构型与心功能进行比较。结果正常左室构型组、向心性重构组中,心功能Ⅰ级的百分比分别为７５．４％和６０．０％,向心性肥厚组及离心性肥厚组心功能Ⅰ级仅占１２．７％和１１．８％;向心性肥厚组左房明显增大（提示左室顺应性下降）,而离心性肥厚组左室收缩功能明显下降。结论临床上对不同的左室构型应采取不同的治疗措施     

原发性高血压病患者左室构型与功能变化的关系

左室肥厚（ＬＶＨ）作为高血压病的危险因素已日益受到重视，但有关其左室几何构型与功能变化的关系，文献报道尚少。作者采用超声多普勒技术对１４２例高血压病患者左室结构及功能进行检测，旨在探讨两者的变化关系。报道如下。１对象和方法１．１对象①高血压病组１５４...     

高血压患者左室重构与心功能及心律失常关系

研究高血压患者左室重构对心律失常及心功能影响。方法应用多普勒超过心动图声学定量技术和动态心电图检测８７例高血压压患者。结论左室重构对高血压早期左室收缩功能有一定代偿作用,但随着心室重构、左室肥大,心脏功能损害更加明显,同时心室重构明显增加室性心律失常的发生。     

心率变异与高血压左室肥厚的关系

心率变异与高血压左室肥厚的关系白梅，郭春风，王彬，王密果，袁风仙高血压患者约１／３有左室肥厚（ＬＶＨ）［Ｈｙｐｅｒ－ｔｅｎ－ｓｉｏｎ，１９８７，９（ｓｕｐｐⅠⅡ）：５３］．ＬＶＨ不仅是一种心血管疾病的标志，而且影响预后。Ｌｅｖｙ等也证明≥４０岁的患者...     

高血压病患者左室几何构型与胰岛素抵抗关系的研究

目的　探讨高血压病 (EH)患者胰岛素抵抗 (IR)对左室几何构型的影响。方法　依照左室质量指数 (LVMI)和相对室壁厚度 (RWT)将 118例EH患者分为左室正常构型组 (5 8例 )、向心性重构组 (2 2例 )、向心性肥厚组 (14例 )、离心性肥厚组 (2 4例 )。并行口服葡萄糖耐量试验和同步胰岛素释放试验 ,计算胰岛素敏感性指数 (ISI)、血糖曲线下面积 (AG)、胰岛素曲线下面积 (AI)、空腹血浆胰岛素 /空腹血糖 (FSI/FSG)比值、AI/AG比值。设对照组 86例。应用单元和多元回归分析观察RWT、LVMI与各胰岛素敏感性指标的关系。结果　与对照组比较 ,EH各左室构型组除FSG外 ,FSI、ISI、AG、AI、FSI/FSG、AI/AG差异均有显著性 (P <0 0 5～P <0 0 1) ,但各构型组间差异无显著性 (P >0 0 5 )。单因素相关分析显示EH组RWT与FSI、AG、AI、收缩压呈正相关 (r值分别为 0 193,0 196 ,0 2 36 ,0 183,P均 <0 0 5 ) ,与ISI呈负相关 (r值为 - 0 2 5 1,P <0 0 1) ,LVMI与体重指数、收缩压、舒张压呈正相关 (r值分别为 0 2 4 2 ,0 2 14 ,0 184 ,P <0 0 5～P <0 0 1) ,而与各胰岛素敏感性指标不相关 (P >0 0 5 )。逐步回归分析显示RWT与ISI呈独立相关 (R2 =0 0 6 3,P =0 0 0 6 )。结论　HIS及IR存在于EH患者各种左室几何     

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。     

The Relationship Between Aortic Stiffness and Left Ventricular Dyssynchrony in Hypertensive Patients with Preserved Left Ventricular Systolic Function

Left ventricular (LV) dyssynchrony is often seen in patients with hypertension, even without heart failure. Arterial stiffness is well accepted as an important factor of increasing blood pressure and influencing ventricular function. The purpose of this study was to determine the relationship between aortic stiffness and LV dyssynchrony in hypertensive patients with preserved LV systolic function. Eighty hypertensive patients with preserved LV systolic function (LV ejection fraction > 50%) and 30 controls were studied. The LV systolic and diastolic dyssynchrony indices were determined as the standard deviation of the time interval from onset of the QRS complex to peak myocardial systolic velocity (Ts-SD) and to early diastolic velocity (Te-SD) and the maximal differences in Ts (Ts-Max) and Te (Te-Max) in 12 LV segments. Aortic stiffness index was calculated from aortic diameters in the systolic and diastolic phases, as measured by echocardiography and blood pressure. No relationship was observed between LV systolic and diastolic dyssynchrony indices (r = 0.057, P = .61). In simple regression, aortic stiffness parameter was related to left ventricular mass index (LVMI), E/A ratio, and LV diastolic dyssynchrony index. But using multiple linear regression, Te-Max remained as a single variable related to aortic strain and aortic stiffness index (r = ?0.271, P = .008 and r = 0.269, P = .008). LVMI was related to aortic distensibility using multiple linear regression (r = ?0.239, P = .02). Aortic stiffness index was related to LV diastolic dyssynchrony index and LVMI. These findings suggest that LV diastolic dyssynchronous changes may be caused by increased LV mass and arterial stiffness.     

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.     

Plasma Norepinephrine and Hemorheology in Essential Hypertensive Patients with Different Patterns of Left Ventricular Hypertrophy

对80例不同类型高血压左室肥厚（LVH）患者的血浆去甲肾上腺素（NE）和血液流变学改变进行观察。结果显示，（1）向心性肥厚组（CH）高切变率下全血粘度（WBV230）显著升高；（2）不对称性室间隔肥厚组（ASH）血浆NE和收缩末期室壁应力（ESS）增高较明显；（3）多元回归分析显示，SBP，ESS和血浆NE是影响相对室壁厚度的重要因素。提示CH是一种对压力负荷过重而产生的代偿形式；ASH的形成除了负荷因素外血浆NE可能起更重要的作用。     

高血压患者左室构型改变与左心舒张功能

目的探讨高血压患者不同左室构型改变与左心舒张功能的关系。方法应用超声心动图和定量组织速度成像技术检测109例原发性高血压患者和26例对照组左心结构及舒张功能各项指标。按照Ganau分类法将高血压患者左室构型分为正常左室构型(A)、向心性重构(B)、向心性肥厚(C)、离心性肥大(D)4种构型,并与对照组(N)比较,对各项指标进行单因素方差分析。结果高血压B、C、D组等容舒张时间(IVRT)延长,后间隔基底段(PS Bas)[N:(84.8±23.4),B:(118.9±34.6),C:(133.1±34.6),D:(161.9±62.5)ms,P<0.05];等容舒张期峰值速度(VIR)B、C组和A组的多数节段高于对照组;对照组16.3%节段出现等容舒张期正向波,83.7%为负向波,高血压组64%节段出现等容舒张期正向波,36%为负向波;快速充盈期心肌沿长轴的峰值速度(Ve)高血压组均低于对照组;B、C两组Ve/Va减低。高血压组左房径均大于对照组,B、C、D组逐渐增大。二尖瓣口血流频谱B、C两组VE/VA<1,而在D组VE/VA>1。结论不同左心室构型高血压患者的左心舒张功能均有减低。应用QTVI能够检出二尖瓣血流频谱VE/VA正常的舒张功能异常,并能检测出等容舒张期局部心肌的异常活动,较频谱多普勒更加敏感。     

Reduced Bone Mineral Density in Hypertensive Patients Is Associated with Left Ventricular Diastolic Dysfunction,Not Left Ventricular Hypertrophy

Left ventricular (LV) hypertrophy and diastolic dysfunction are commonly observed in hypertensive patients, and have been demonstrated to be risk factors of chronic heart failure due to LV diastolic dysfunction. Recently, reduced bone mineral density has been found in hypertensive patients compared with healthy controls. However, relationships between bone mineral density and LV hypertrophy and diastolic dysfunction have not been fully assessed. We examined relationships between bone mineral density and both LV hypertrophy and diastolic dysfunction in 38 hypertensive patients (23 males, 15 females; mean age 71 ± 8 y) who had been treated with antihypertensive drugs for at least 1 year. The bone mineral density of the calcaneus was measured with a quantitative ultrasound measurement device (A-1000 EXPRESS/InSight, GE Healthcare, Horten, Norway), and the stiffness index was determined as a parameter of bone mineral density. Echocardiography was performed to measure the left ventricular mass index as a parameter of LV hypertrophy. Left ventricular diastolic dysfunction was also assessed by early diastolic mitral annular velocity (e′), and the ratio of early transmitral flow velocity (E) to e′ (E/e′). The bone mineral density did not correlate with left ventricular mass index, but did correlate with e′ (r = 0.453, P < .01) and E/e′ (r = ?0.359, P < .05). Thus, reduced bone mineral density in hypertensive patients is not associated with LV hypertrophy but with LV diastolic dysfunction. Hypertensive patients with reduced bone mineral density may have a high risk of chronic heart failure due to LV diastolic dysfunction as well as bone fractures due to osteoporosis.     

逆转高血压左心室肥厚对心肌缺血和心律失常的影响

观察 2 0例冠状动脉造影证实无明显狭窄病变的高血压左室肥厚 (LVH )者 ,经尼群地平和巯甲丙脯酸治疗 1～ 2年 ,LVH逆转后对心肌缺血和室性心律失常的影响。结果表明 ,治疗前休息或运动时心电图ST段缺血性压低的 14例中 ,有 9例(6 4% )治疗后心肌缺血消失 ;室性心律失常发生率无变化 ,但Lown氏分级程度有减轻趋势。结果提示 ,逆转高血压LVH是改善心肌缺血的一个有效的治疗途径     

卡托普利治疗高血压左室肥厚和左室舒张功能的临床分析

目的探讨卡托普利对高血压左室肥厚与左室舒张功能的治疗作用。方法对符合ＷＨＯ诊断标准的原发性高血压病左室肥厚患者５２例,服用卡托普利治疗,用多普勒彩色超声心动图测定治疗前后左室肥厚指标,左室舒张及收缩指标。结果治疗后室间隔厚度,左室后壁厚度,左室心肌重量,左室心肌重量／左室容量均明显减小,舒张早期流速峰值明显增大,房缩期最大流速下降,两者比值下降,左室射血分数无变化。结论卡托普利可有效地抑制并逆转左室肥厚,改善左室舒张功能