高血压左室肥厚及构型与室性心律失常的关系

为探讨高血压左室肥厚(LVH)及不同构型与室性心律失常的关系,对320例有或无左室肥厚(LVH)高血压患者进行超声心动图、24h动态心电图检测.结果表明:LVH为105例,检出率为32.8%.复杂性室性心律失常的发生率在有无LVH组间有显著性差异(P<0.05),LVH程度与复杂性室性心律失常级别有密切的关系(r=0.57,p<0.05),LVH不同构型之间复杂性室性心律失常的发生率存在显著差异(p<0.05),不对称性LVH发生率较高.因此,对于肥厚程度较重、不对称LVH的高血压患者要给予高度重视.     

一氧化氮与原发性高血压及左室肥厚的关系

目的 探讨一氧化氮（NO）在原发性高血压（EH）患者中的变化，以及与左室肥厚（LVH）的关系。方法 分别选取EH有LVH患者、EH无LVH患者及正常人各30例，检测NO水平及左室重量（LVM），进行组间比较及相关分析。结果 1．EH有LVH组NO水平明显低TEH无LVH组、正常对照组，EH无LVH组NO水平明显低于正常对照组；而室间隔舒张末期厚度（IVS）、左室后壁舒张末期厚度（LVPw）、LVM水平相反俨〈0．01）。2．血压与NO呈负相关、与LVM呈正相关，NO与LVM呈负相关（r〉0或，〈0，P〈0．01或〈0．05）。结论 NO参与了EH及LVH形成的病理生理过程。     

原发性高血压左心室肥厚及构型与冠状动脉狭窄的关系

目的 探讨原发性高血压左心室肥厚(LVH)及不同构型与冠状动脉狭窄的关系。方法 对1 47例有或无左心室肥厚(LVH)的原发性高血压患者进行超声心动图和冠状动脉造影检测。结果 原发性高血压LVH的程度与其发生冠状动脉狭窄级数的相关系数为r=O.58(P相似文献   

原发性高血压24小时脉压与左心室肥厚

目的：探讨原发性高血压患者脉压与左心室肥厚的关系。方法：97例原发性高血压患者按脉压高低被分为≤60mmHg和〉60mmHg两组。超声心动图测量舒张末期室间隔厚度、舒张末期左心室内径、舒张末期左心室后壁厚度。求出左心室质量指数（LVMI）。结果：高脉压组年龄较大．LVMI显著高于低脉压组[（135．3±23．5：（115．7±25．2）,P〈0．01]。结论：24h脉压高者更易发生左心室肥厚。     

高血压病左室肥大Q-T离散度异常与室性心律失常的关系

观察180例高血压病患者的Q-T离散度(Q-Td),左室肥大组及左室正常组Q-Td分别为67.31±13.57和38.8±8.55ms(P<0.001),左室肥大组室性心律失常检出率为92.5%,其中复杂性者为64.2%,室速为23.9%,该组中Q-Td>60ms 3项检出率均高于<60ms及左室正常组中Q-Td>60ms者,复杂性室性心律失常及室速有显著性差异(P<0.001).提示高血压左室肥大Q-Td增加与室性心律失常尤其是复杂性室性心律失常及室速有一定关系,结合左室重量指数(LVMI)和Q-Td可作为评估高血压病患者预后的参考指标.     

一氧化氮和内皮素在高血压左室肥厚形成中的作用

目的 探讨一氧化氮（NO）和内皮素（ET）在高血压左室肥厚（LVH）形成中的作用。方法 采用放射免疫分析法（RIA）和硝酸还原酶法检测30例单纯原发性高血压（EH,观察Ⅰ组）、30名健康体检者（对照组）及20例EH伴LVH（观察Ⅱ组）患者降压治疗前后血清ET、NO水平。并对结果进行相关分析。结果 观察Ⅰ组血清ET明显高于对照组、NO明显低于对照组（P均〈0．01）;观察Ⅱ组血清ET明显高于观察Ⅰ组、NO明显低于观察Ⅰ组（P均〈0．01）,且ET与NO水平呈负相关（r=0．586,P〈0．01）;左心室重量指数（LVMI）与ET呈正相关（r=0．427,P〈0．05）、与NO呈负相关（r=0．653,P〈0．01）。观察Ⅱ组治疗后,血清ET水平明显低于治疗前、NO水平明显高于治疗前（p均〈0．01）。结论 ET和NO两者失衡可能参与了EH及LVH形成的病理生理过程。     

沉默信息调节因子相关酶3在自发性高血压大鼠心肌高表达与左心室肥厚相关

目的观察沉默信息调节因子相关酶3(sirtuin3)在自发性高血压大鼠(SHR)心肌中的表达,并探讨sirtuin3在高血压所致左心室肥厚(LVH)中的作用。方法 24只29周龄SHR随机分为SHR30周龄组(喂养1周,n=11)和SHR38周龄组(喂养9周,n=13),另选20只29周龄Wistar-Kyoto(WKY)大鼠随机分为WKY30周龄组(喂养1周,n=10)和WKY38周龄组(喂养9周,n=10)作为正常对照。各组测定尾动脉收缩压和左心室质量(LVM)/体质量。Masson染色法分析左心室肌间质纤维化程度,心脏超声测定心功能。采用免疫组化,Western-blot及实时荧光定量PCR来检测心肌组织中sirtuin3的蛋白及mRNA表达。结果与WKY30、38周龄组大鼠比较,SHR30、38周龄组的收缩压[30周龄(189.0±6.8)比(103.4±3.6)mmHg;38周龄(205.6±10.9)比(116.3±4.3)mmHg]、LVM/体质量[30周龄(2.94±0.11)比(2.56±0.21);38周龄(3.21±0.15)比(2.68±0.24)]、左心室收缩末期内径[30周龄(4.27±0.13)比(3.59±0.08)mm;38周龄(5.46±0.14)比(4.21±0.08)mm]、舒张末期室间隔厚度[30周龄(2.63±0.15)比(2.09±0.06)mm;38周龄(2.82±0.09)比(2.35±0.08)mm]、舒张末期左心室后壁厚度[30周龄(2.78±0.12)比(2.15±0.09)mm;38周龄(2.99±0.12)比(2.44±0.07)mm]、sirtuin3mRNA和蛋白表达升高(均P<0.05);左心室短轴缩短率、左心室舒张末期内径降低(均P<0.05),SHR大鼠表现出左心室明显肥厚,左心室收缩及舒张功能明显减低,并随着周龄的延长,心肌肥厚及心功能障碍加重(P<0.05)。结论心肌组织sirtuin3高表达与左心室肥厚密切相关。     

Relationship between hypertensive left ventricular hypertrophy, neurohormonal factors and ventricular arrhythmias in very old patients

OBJECTIVE: To study the relationship between hypertensive left ventricular hypertrophy (LVH) in very old patients (> or = 80 years) with neuro-hormonal factors and ventricular arrhythmias. METHODS: Heart rate variation, plasma renin (Ren), angiotensin-II (AT-II), aldosterone (Ald), insulin (Ins), Holter and ambulatory blood pressure monitoring were measured in 60 cases (> or = 80 years) which were divided into 2 groups: 30 with primary hypertension accompanied LVH in very old patients (group A); 30 with simple primary hypertension (group B). RESULTS: There was no significant difference of AT-II and Ren between group A and B (P > 0.05); Ins and Ald values in group A was much higher than in group B (P all < 0.01); the data of heart rate variability, including very low frequency (VLF) and low frequency (LF) and LF/HF (high frequency) in group A were significantly higher than in group B (P < 0.01, < 0.05, < 0.05, respectively); incidence of premature ventricular contractions (PVC) and myocardial ischaemia in group A were higher than in group B patients. CONCLUSIONS: Sympathetic nerve excitability in group A was greatly increased; hypertensive LVH was closely associated with Ald and Ins level, but not with AT-II and Ren. Group A is characterized by a significantly greater frequency of premature ventricular contractions and ischaemia.     

高血压患者脉压与左心室肥厚构型及心功能的关系

目的　探讨药物规则治疗下高血压病 (EH)患者的脉压 (PP)与左心室肥厚 (L VH)构型及心功能的关系。方法　本研究回顾性分析 176例有或无 L VH的 EH患者的 PP与 L VH构型及心功能的相关性。结果　 1不对称性室间隔肥厚 (ASH)、对称性室间隔肥厚 (CH)及扩张性肥厚 (DH)三型肥厚组的 PP与无 L VH组相比 ,有明显的差别 ,CH和 DH组较大 (P均 <0 .0 1) ,尤以 DH组较甚。2随着 PP增大 ,左心室收缩及舒张功能均明显的降低。3L ogistic回归分析显示 ,PP与 EH患者左心功能不全发生存在明显的相关性 ,PP每增加 10 m m Hg,左心功能不全增加 30 % (95 % CI:1.2 3～ 1.37,P<0 .0 0 0 1) ;在对年龄和 EH病程进行校正后 ,PP每增加 10 m m Hg显示增加左心功能不全发生率 19% (95 % CI:1.13～ 1.2 5 ,P<0 .0 0 0 1)。结论　在药物规则治疗的 EH患者中 ,PP与 L VH构型具有一定的联系 ,PP是左心功能不全发生的一个重要和独立的相关因素 ;且随着 PP增大 ,左心室收缩及舒张功能均明显的降低。     

透析患者甲状旁腺机能亢进与左心室肥厚的关系

目的　了解透析患者甲状旁腺机能亢进与左心室肥厚 (L VH)的相关关系。方法　分别测量我院 46例腹膜透析 (CAPD)患者、73例血液透析 (HD)患者、18例透析前慢性肾衰竭患者及 16例健康人的超声心动图 ,以了解左心室肥厚的发生率 ,并分别检查血甲状旁腺素 (i PTH)、钙、磷水平 ,分析血钙、磷、i PTH与 L VH之间的关系。结果　CAPD组、HD组、肾衰竭组的 i PTH较对照组明显增高 (P<0 .0 0 1) ,以肾衰竭组升高明显 ,并且与 L VH呈显著正相关 (r=0 .70 5 ,P<0 .0 0 1)。 CAPD组、HD组的血钙值、血磷值与对照组无明显差别 ,而慢性肾衰竭组则血钙明显低下、血磷明显升高。结论　尿毒症患者普遍存在甲状旁腺机能亢进 ,是导致透析患者心血管疾病发病率增高的原因之一     

老年高血压病患者血浆内皮素与左室重量和功能关系的研究

目的探讨老年高血压病患者(EH)血浆内皮素(ET)与左室重量和功能的关系。方法采用放射免疫分析法和多昔勒超声心动图技术检测86例EH患者和57例健康对照者血浆ET的浓度及室间隔(IVST)、左室后壁厚度(PWT)、左室心肌重量指数(LVMI)以及左室流入道E峰和A峰比值(E/A)、E峰加速面积(EAA)。结果EH组ET、IVST、PWT、LVMI显著高于对照组(P值均＜0．01),E/A、EAA显著低于对照组(P＜0．01);EH组ET与IVST、LPWT、LVMI之间均存在着显著正相关(P值均＜0．01),ET与E/A、EAA之间均存在着显著负相关(P值均＜0．01)。结论ET可能是引起EH患者左室肥厚及舒张功能不全的原因之一。     

高血压左室肥厚与脑卒中的相关性分析

目的：探讨高血压病引起的左心室肥厚、左心室重量增加对房室传导、心肌细胞复极离散度及脑卒中的影响。方法：临床确诊的高血压病人188例，采用超声心动图测量室间隔厚度及左心室重量，心电图测量P—Rd、Q—Td、J—Td。结果：合并左室肥厚者108例，不合并左室肥厚者80例。左室肥厚组患者P—Rd、Q—Td、J—Td及脑卒中发生率明显高于不合并左室肥厚者。结论：高血压左室肥厚与房室传导时限、心室肌复极的一致性及脑卒中发生率密切相关，可能成为预测脑卒中发生的危险因素之一。     

男性瘦素水平与原发性高血压左室肥厚的相关性研究

目的 :研究瘦素 (leptin)与原发性高血压 (EH)左室肥厚 (LVH)的相关性 ,从而进一步探讨LVH的发病机制。方法 :随机选择确诊EH男性患者 4 1例 ,选正常健康男性 2 3例作为对照。晨空腹测定血清leptin水平、血清胰岛素和血糖水平 ,胰岛素与血糖乘积的倒数即胰岛素敏感性指数 (ISI)作为评价胰岛素抵抗 (IR)的指标。心脏彩超测定室间隔厚度 (IVST)、左室后壁厚度 (PWT) ,IVST与PWT之和即左室壁厚度和 (SWT)作为评价LVH的指标。采用相关分析、多元逐步回归等统计方法进行评价。结果 :EH组与对照组具有可比性 ,两者之间leptin水平有统计学意义 (P <0 .0 1)。在EH组 ,leptin水平与SWT显著相关 (r =0 .5 1,P <0 .0 1)。多元逐步回归分析显示 ,血清leptin水平和ISI与SWT相关性好。 结论 :男性血清leptin水平与EHLVH具有良好的相关性。     

老年高血压病患者血浆内皮素与左室重量和功能关系的研究

目的探讨老年高血压病患者（ＥＨ）血浆内皮素（ＥＴ）与左室重量和功能的关系。方法采用放射免疫分析法和多普勒超声心动图技术检测８６例ＥＨ患者和５７例健康对照者血浆ＥＴ的浓度及室间隔（ＩＶＳＴ）、左室后壁厚度（ＰＷＴ）、左室心肌重量指数（ＬＶＭＩ）以及左室流入道Ｅ峰和Ａ峰比值（Ｅ／Ａ）、Ｅ峰加速面积（ＥＡＡ）。结果ＥＨ组ＥＴ、ＩＶＳＴ、ＰＷＴ、ＬＶＭＩ显著高于对照组（Ｐ值均＜０．０１）,Ｅ／Ａ、ＥＡＡ显著低于对照组（Ｐ＜０．０１）;ＥＨ组ＥＴ与ＩＶＳＴ、ＬＰＷＴ、ＬＶＭＩ之间均存在着显著正相关（Ｐ值均＜０．０１）,ＥＴ与Ｅ／Ａ、ＥＡＡ之间均存在着显著负相关（Ｐ值均＜０．０１）。结论ＥＴ可能是引起ＥＨ患者左室肥厚及舒张功能不全的原因之一。     

Ventricular arrhythmias in hypertensive left ventricular hypertrophy. Relationship to coronary artery disease, left ventricular dysfunction, and myocardial fibrosis

Ventricular arrhythmias occur with increased frequency in hypertensive patients with left ventricular hypertrophy (LVH). The relationships, however, between ventricular arrhythmias and coexistent coronary artery disease, left ventricular dysfunction and left ventricular fibrosis have not been examined in hypertensive LVH. We carried out coronary arteriography on fifteen hypertensive patients with LVH and nonsustained ventricular tachycardia (greater than or equal to 3 consecutive ventricular complexes) of whom nine (60%) were free of significant (greater than 50% stenosis) coronary disease. To identify other possible correlates of left ventricular arrhythmias, 28 patients with LVH, comprising 17 with ventricular tachycardia and 11 without ventricular arrhythmias, underwent quantitative assessment of left ventricular function (angiographic ejection fraction), left ventricular mass (echocardiography), and left ventricular fibrosis (endomyocardial biopsy). Ejection fraction was not significantly different between the two groups (53 +/- 8% v 62 +/- 2%, P = NS). However, left ventricular mass was significantly greater (442 +/- 28 g v 339 +/- 34 g, P less than .05) and percentage fibrosis significantly higher (19 +/- 4% v 3 +/- 1%, P less than .001) in those patients with ventricular tachycardia. Thus ventricular arrhythmias in hypertensive patients with LVH cannot be entirely attributed to coexistent coronary disease, nor to left ventricular dysfunction, but are related to the degree of cardiac hypertrophy and subendocardial fibrosis.     

B-type natriuretic peptide and left ventricular hypertrophy in hypertensive patients.

AIM: To assess the accuracy of B-type natriuretic peptide (BNP) plasma levels for the diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients. PARTICIPANTS AND METHODS: We studied a sample of 409 adults aged 45 years or older, recruited from residents of Porto by random digit dialing. Data were collected by clinical interview and physical examination, ECG, echocardiogram and venous blood sampling for the measurement of plasma concentrations of BNP. Hypertension (HT) was defined as blood pressure > or = 140/90 mmHg on the day of interview and/or self-reported HT if treated with any antihypertensive medication; LVH was defined as left ventricular mass index (LVMI) > or = 125 g/m2 in men and 110 g/m2 in women. The participants were further classified in four strata according to left ventricular morphology--normal, concentric remodeling, eccentric LVH or concentric LVH. RESULTS: Two hundred and thirty-two (56.7%) individuals were hypertensive, and among these 73 (31.5%) had LVH. BNP levels were significantly higher in these individuals (median [P25-P75] = 55.8 pg/ml [22.6-88.4]) than in hypertensive patients without LVH (29.9 pg/ml [10.0-62.8]), p = 0.003. BNP levels also differed significantly across strata of left ventricular geometry, the main difference depending on the presence or absence of LVH. There was a positive correlation between plasma BNP levels and LVMI (Spearman's P 0.185, p = 0.005). The area under the ROC curve--a parameter for diagnostic accuracy quantification--was 0.62 (95% confidence interval 0.54-0.70), indicating low discriminatory power between normal and abnormal LVMI. CONCLUSION: In the assessed population, BNP levels were higher in hypertensive patients with LVH than in the absence of LVH. However, BNP did not perform well in discriminating between the presence or absence of LVH.     

Impaired left ventricular functional reserve in hypertensive patients with left ventricular hypertrophy

To determine whether patients with hypertension and especially those with left ventricular hypertrophy have subtle changes in cardiac function, we measured the increase in left ventricular ejection fraction and in systolic blood pressure to end-systolic volume index ratio with exercise in 40 hypertensive patients and 16 age-matched normotensive volunteers. Twenty-two hypertensive patients without hypertrophy had normal end-systolic wall stress at rest and exercise responses. In contrast, the 18 patients with echocardiographic criteria for left ventricular hypertrophy demonstrated a significant increase in end-systolic wall stress at rest compared with normal subjects (69 +/- 16 vs. 55 +/- 15 10(3) x dyne/cm2, p less than 0.05) despite having normal resting left ventricular size and ejection fraction. In patients with left ventricular hypertrophy, the increase in ejection fraction with exercise was less than in the normotensive control subjects (7 +/- 7 vs. 12 +/- 8 units, p less than 0.05), and delta systolic blood pressure to end-systolic volume with exercise was reduced (3.3 +/- 3.8 vs. 8.3 +/- 7.7 mm Hg/ml/m2, p less than 0.05). The hypertensive patients with hypertrophy displayed a shift downward and to the right in the relation between systolic blood pressure to end-systolic volume ratio and end-systolic wall stress compared with control subjects and hypertensive patients without left ventricular hypertrophy. Thus, hypertensive patients with left ventricular hypertrophy by echocardiography and normal resting ejection fraction exhibit abnormal ventricular functional responses to exercise. This finding may have implications in identifying patients at higher risk for developing heart failure.     

收缩压与高血压左室重构的关联

目的探讨动态血压参数变化与高血压左心室重构之间的关系。方法对105例原发性高血压患者进行超声心动图检查;24小时动态血压监测获取动态血压参数。采用多元回归方法对左心室质量（LVM）与动态血压各参数作逐步回归分析。结果24 h平均收缩血压和白天收缩血压均值与左心室重构有关。结论收缩血压是影响左心室重构的主要危险因素。