脑钠肽与高血压左室重塑、左室功能的关系

目的: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,依照左室重量指数(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)。应用相关性分析了解EH组LVMI、RWT、年龄、血压、体质指数(BMI)、左室射血分数(LVEF)等因素与BNP关系。结果:在EH各构型亚组中LVMI以离心性肥厚亚组最高,向心性肥厚亚组、离心性肥厚亚组BNP水平较对照组升高明显。EH组LVMI与BNP具有明显的正相关性(r=0.605,P<0.01),RWT与BNP具有明显的负相关(r=-0.266,P<0.01),LVEF与BNP呈负相关(r=-0.552,P<0.01),LVMI、RWT与血压、BMI之间无明显相关性。结论:EH组中不同的左室几何构型对BNP水平产生不同影响,具有更高的LVMI值和更低的LVEF、RWT值患者,BNP水平更高,而年龄、血压、BMI与BNP、LVMI、RWT无明显相关性。     

The effect of left ventricular geometry on myocardial performance index in hypertensive patients]

OBJECTIVE: The aim of this study was to investigate the relationship between the myocardial performance index (MPI) and left ventricular (LV) geometry in hypertensive patients. METHODS: The MPI, which is a marker of systolic and diastolic ventricular function, was measured in 64 hypertensive patients and in 15 healthy persons (Control). According to the value of relative wall thickness (RWT) and LV mass index (LVMI), hypertensive patients were subdivided into four groups: normal (N), 17 patients (26.6%); concentric remodeling (CR), 21 patients (32.8%); concentric hypertrophy (CH), 16 patients (25%); and eccentric hypertrophy (EH), 10 patients (15.6%). RESULTS: A higher MPI was found in all patient groups (N, 0.56+/-0.11; CR, 0.59+/-0.11; CH, 0.68+/-0.19; EH, 0.57+/-0.10) compared with the controls (0.44+/-0.09) (p=0.004, p<0.001, p<0.001 and p = 0.002, respectively). In the CH group, the MPI was also higher than in N, CR and EH groups (p=0.006, p<0.03 and p=0.009, respectively). No significant difference was found among N, CR and EH groups. The MPI was correlated with LVMI (r=0.28, p=0.014), RWT (r=0.24, p=0.035) and interventricular septum diastolic thickness (r=0.32, p=0.004). CONCLUSION: The systolic and diastolic LV functions are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric hypertrophy than in those with the other LV geometric patterns.     

Left ventricular hypertrophy and geometry in untreated essential hypertension is associated with blood levels of aldosterone and procollagen type III amino-terminal peptide.

BACKGROUND: The present study examined the role of aldosterone in left ventricular hypertrophy (LVH) and geometry in patients with untreated essential hypertension (EHT), and investigated the contribution of myocardial fibrosis to the process of LVH. METHODS AND RESULTS: The relationship of the plasma aldosterone concentration (PAC) to LVH and left ventricular (LV) geometry was investigated in 57 consecutive patients with untreated EHT. PAC correlated with both LV mass index (LVMI: r=0.46, p=0.0004) and relative wall thickness (RWT: r=0.33, p=0.013). In patients with LVH (LVMI > or =125 g/m(2)), the serum concentration of procollagen type III amino-terminal peptide (PIIINP), a marker of myocardial fibrosis, correlated with RWT (r=0.46, p=0.029). These patients were divided into 2 groups: concentric hypertrophy (CH) with RWT > or =0.44, and eccentric hypertrophy (EH) with RWT <0.44. The serum PIIINP concentration was significantly higher in the CH group than in the EH group (0.52+/-0.02 ng/ml vs 0.44+/-0.03 ng/ml, respectively; p<0.05). CONCLUSIONS: Aldosterone may be involved in LVH and LV geometry, particularly in the development of CH. Myocardial fibrosis seems more strongly involved in the hypertrophic geometry of CH than with EH.     

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.     

N-Terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age?=?51.7?±?5.8 years) and 44 healthy control subjects (mean age; 51.3?±?4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p?p?p?>?0.05). NT-proBNP was independently associated with LV geometry (β?=?0.304, p?=?0.003) and LVMI (β?=?0.266, p?=?0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.     

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.     

QT dispersion and left ventricular geometry in hypertensive patients

It has been shown that increased QT dispersion (QTd) reflects electrical inhomogeneity of the myocardium and is associated with high incidence of ventricular arrhythmias. In some cases increased QTd has also been found in some hypertensive patients with left ventricular hypertrophy. The aim of the study was to investigate the relation between QTd and left ventricular (LV) geometry in hypertensive patients (pts). Studied group consisted of 80 pts aged 52.5 +/- 12.6 yrs with mild, moderate and severe hypertension. Nineteen healthy subjects aged 50.5 +/- 9.6 yrs served as control group. QTd was calculated as a difference between the longest QT and shortest QT from the 12-leads of the standard electrocardiogram. Each subject underwent echocardiographic study to determine the pattern of LV geometry divided into: normal (NG), concentric remodeling (CR), excentric hypertrophy (EH) and concentric hypertrophy (CH). Significantly higher QTd was found out in pts with CH and EH as compared to CG (respectively 61 +/- 10 ms, 69 +/- 15 ms vs 46 +/- 14 ms, p < 0.01). Moreover, pts with CH had higher QTd than NG (69 +/- 15 ms vs 55 +/- 15 ms, p < 0.01). CONCLUSION: QTd is related to the pattern of LV geometry. As compared to healthy subjects it is increased in hypertensive pts with concentric and eccentric hypertrophy. In pts with CH QTd is significantly greater than in hypertensive pts with normal geometry.     

原发性高血压患者血清脑利钠肽水平与左室重构的关系

目的　探讨原发性高血压(EH)患者血清脑利钠肽(BNP)水平与左室重构的关系。方法　用酶联免疫吸附法(ELISA)测定38例EH患者和2 0例健康对照者的血清BNP浓度;对EH患者进行超声心动图检查,按检查发现分为EH左室重构组(14例)和EH正常构型组(2 4 )例。结果　EH左室重构组血清BNP水平(3 .31±1 .5 8ng/ml)明显高于EH正常构型组(1. 83±0 .6 5ng/ml)和健康对照组(1 .94±0 . 97ng/ml) (P <0 . 0 1) ,EH正常构型组与健康对照组比较无显著性差异;EH患者血清BNP水平与左室重量指数(LVMI)、平均室壁厚度(WT)呈正相关(P <0 . 0 5 )。结论　有左室重构的EH患者血清BNP水平明显升高,血清BNP水平能反映EH患者左室结构的异常。     

Effect of insulin resistance on left ventricular structural changes in hypertensive patients

Both left ventricular (LV) hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth promoting effect on cardiomyocytes rather than affecting the LV internal diameter. The purpose of this study was to examine the effect of IR on LV geometry. We enrolled 105 patients (71 females, mean age, 49.2 +/- 13.6 years) with recently diagnosed and untreated hypertension (blood pressure > 140 and/or 90 mmHg, fasting glucose < 110 mg/dL), and grouped them as normal (N) (39 patients, 26 females, mean age, 48.5 +/- 14.7 years) if all M-mode echocardiographic measurements were within normal limits, concentric remodeling (CR) (22 patients, 15 females, mean age, 50.5 +/- 14.8 years) if relative wall thickness was increased but left ventricular mass index (LVMI) was normal, concentric hypertrophy (CH) (13 patients, 9 females, mean age, 50.3 +/- 10.8 years) if both ventricular thicknesses and the LVMI were increased, and eccentric hypertrophy (EH) (31 patients, 21 females, mean age, 48.6 +/- 12.9 years) if ventricular thicknesses were normal, but LVMI was increased. Transthoracic echocardiography was performed in all subjects, and interventricular septal thickness (IVS), posterior wall thickness (PWT), sum of wall thickness (SWT), left ventricular end-diastolic internal diameter (LVED), relative wall thickness (RWT), and LVMI were recorded. Blood samples for routine biochemical examination and fasting insulin levels were obtained and then the homeostasis model assessment (HOMA) index was calculated by the formula: HOMA Index = Fasting Blood Glucose (mg/dL) x Immunoreactive Insulin (microU/mL)/405, for the assessment of IR. There were no significant differences among the groups with respect to age, blood pressure (BP) levels, fasting blood glucose (FBG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), total cholesterol (TC), or triglyceride (TG) levels. Insulin levels were significantly higher in the CR and CH groups in comparison with the N group (P = 0.004), and the HOMA index was higher in the CH group compared to the N group (P = 0.024). In Pearson's correlation analysis, insulin was found to be directly correlated with IVS (r = 0.29, P = 0.002), SWT (r = 0.25, P = 0.009), and RWT (r = 0.33, P = 0.0001). The HOMA index was also directly correlated with IVS (r = 0.33, P = 0.001), SWT (r = 0.29, P = 0.002), and RWT (r = 0.29, P = 0.003). Cardiac changes in hypertensive patients include increased LVMI and altered LV geometry. The concentric LV geometry seen in hypertensive patients might be mediated, at least in part, by increased insulin levels and the HOMA index.     

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     

高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。     

Effects of spironolactone during an angiotensin II receptor blocker treatment on the left ventricular mass reduction in hypertensive patients with concentric left ventricular hypertrophy.

BACKGROUND: Angiotensin II receptor blockers (ARB) are now commonly used to treat hypertension because of their beneficial effects on cardiovascular remodeling. However, ARB treatment can not inhibit the left ventricular (LV) remodeling sufficiently, which may be related with aldosterone secretion. To inhibit the action of aldosterone during ARB treatment, the additional effects of an aldosterone blocker and spironolactone (SPRL) on LV hypertrophy in patients with essential hypertension was studied. METHODS AND RESULTS: The patients with essential hypertension were randomly divided into 2 groups; 1 group was treated with an ARB, candesartan (8 mg/day), for 1 year (ARB group) and other group was treated with the ARB for the first 6 months and with the ARB plus SPRL (25 mg/day) for the next 6 months (combination group). Seventy patients who underwent echocardiography every 6 months were analyzed and were also classified into 4 subgroups of LV geometric pattern according to the LV mass index (LVMI) and the relative wall thickness (RWT). The ARB treatment and the addition of SPRL significantly reduced the blood pressure, however, both treatments did not affect the LV geometry in both groups. The ARB treatment in the subgroups of concentric LV remodeling (RWT>or=0.45 and LVMI<125) and concentric LV hypertrophy (RWT>or=0.45 and LVMI>or=125) significantly reduced RWT. However, ARB treatment in all subgroups did not affect LVMI. The addition of SPRL only in the concentric LV hypertrophy subgroup significantly reduced the LVMI, despite similar changes in blood pressure. CONCLUSIONS: These results indicated that the addition of SPRL treatment during the ARB treatment and conventional treatments is clinically useful to reduce the LVMI in hypertensive patients with concentric LV hypertrophy; however, does not improve the eccentric LV hypertrophy.     

Relation of circulating blood volume to left ventricular geometry in essential hypertension.

To investigate whether circulating blood volume contributes to left ventricular (LV) geometry, 60 outpatients with untreated, mild to moderate essential hypertension and 45 normotensives were studied. Based on echocardiographic LV mass index and relative wall thickness, four patterns of LV geometry, i.e., normal left ventricle, concentric remodeling, eccentric hypertrophy and concentric hypertrophy, were identified. Plasma volume and blood volume were measured by the 131I labeled human serum albumin technique. LV end-diastolic volume was greater in patients with eccentric hypertrophy than in the groups of patients with normal left ventricles, concentric remodeling, or concentric hypertrophy or in normotensive subjects. No differences were found in systolic function among the five groups. Both plasma volume and blood volume were decreased in the concentric remodeling group as compared with the other four groups. However, there were no differences in plasma volume or blood volume among the normal left ventricle, eccentric hypertrophy and concentric hypertrophy groups. These data indicate that a small LV chamber in cases of "concentric remodeling" may be related to decreased plasma and blood volumes, but an enlarged LV chamber in cases of "eccentric hypertrophy" is not likely to be related to either plasma or blood volume levels in mild to moderate untreated essential hypertension.     

Changes and significance of subtype function of beta-adrenoreceptors in left ventricular remodeling of hypertension

Changes in the density of myocardium and blood lymphocyte beta-adrenoceptors (beta-AR) in left ventricular (LV) geometry have been found in patients with essential hypertension (EH). However, it is not known whether intrinsic beta-AR subtype function changes during left ventricular remodeling of hypertension. The purpose of this study was to further investigate the changes and clinical significance of beta-AR subtype function in LV remodeling in patients with EH. One hundred and thirty-four men (mean age, 53 years) with EH as defined in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure grades 1 to 2 and 40 normotensives were studied. Based on the echocardiographic LV mass index and relative wall thickness, four patterns of LV geometry, ie, normal left ventricle, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were identilied. beta-Adrenoreceptor subtype responsiveness was measured by a treadmill exercise test (to measure cardiac beta1-adrenoreceptor responsiveness) and by Salbutamol injection test (to measure cardiac beta2-adrenoreceptor responsiveness) in 134 male patients with EH. Forty normotension subjects were also studied as controls. In patients with EH in the groups of concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, heart rate in response to the treadmill test (peak exercise-resting rate) was significantly higher (P < 0.05, P < 0.01. P < 0.01, respectively) than that in the control group. In the concentric remodeling and concentric hypertrophy group, the chronotropic doses of salbutamol required to increase the heart rate by 30 beats/min (CD30) were significantly lower (P < 0.05, P < 0.01, respectively) than that in the control group. However, in the eccentric hypertrophy group. CD30 was higher significantly (P < 0.01) than that in the control group. In the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups, beta1-AR responsiveness significantly increased them in the normotensive group, whereas beta2-AR responsiveness significantly increased in the concentric remodeling and concentric hypertrophy groups them in the normotensive group, and significantly decreased in the eccentric hypertrophy them in the normotensive group. The results suggest that non-beta-selective blocker may be beneficial for normal morphology, concentric remodeling and concentric hypertrophy, while beta1-selective blockers may be beneficial for eccentric hypertrophy in patients with EH.     

Effects of gestational hypertension on left ventricular geometry

BACKGROUND: During pregnancy heart rate, stroke volume, cardiac output and left ventricular (LV) mass increase while peripheral vascular resistance decreases. Gestational hypertension (GHT) which is noted in some pregnancies during the third trimester, is considered a temporary condition. Its effects on LV geometry are not known. AIM: To assess the effects of acute pressure overload in GHT on the LV geometry. METHODS: Forty three pregnant women (mean age 28.7+/-8.9 years) with GHT were included in the study (Group A). Blood pressure levels >140/90 mmHg were considered diagnostic for GHT. Fifty six pregnant women (mean age 25.7+/-5.7 years) with normal blood pressure formed the control group (Group B). Transthoracic echocardiography was performed in all subjects before delivery. LV end-systolic (ESD) and end-diastolic (EDD) diameters, LV septal and posterior wall thickness were measured, and LV mass index (MI) as well as relative wall thickness (RWT) were calculated using Devereux and Ganau formulas. LV geometry was defined as normal (N), concentric hypertrophic (CH), eccentric hypertrophic (EH) or concentric remodelling (CR). RESULTS: LVMI and RWT were 138+/-13.8 g/m2 and 0.46+/-0.09 in Group A, and 117+/-15 g/m2 and 0.4+/-0.03 in Group B (p=0.01 and p=0.03). LV geometry patterns were: 38.9% - N, 19.4% - EH, 14% - CH and 27.7% - CR in group A and 78.6% - N, 7% - EH, 5.4% - CH and 9% - CR in normotensive pregnancies (p<0.001). CONCLUSIONS: These findings suggest that LVMI and RWT are greater in GHT compared to normotensive pregnant women. Most frequently observed abnormal geometric patterns are EH and CR.     

Cornell指数对高血压病患者左室构型的诊断价值

目的:观察心电图Cornell指数对高血压病左室肥厚以及左室肥厚不同几何构型的诊断价值。方法:选用本院住院以及门诊高血压病患者96(男50,女46)例,年龄(54±14)岁。根据心脏超声检查的结果,将入选患者分为4组:①正常几何形态(normal geometry,N);②向心性重构(concentric remodeling,CR);③向心性肥厚(concentrichypertrophy,CH);④离心性肥厚(eccentric hypertrophy,EH),观察心电图Cornell指数在各组中的阳性率。结果:Cornell指数均能明显区分正常心脏形态及左心室肥厚;在不同左室肥厚构型中,Cornell电压指数2.8 mV(男)和Cornell电压指数2.0 mV(女)以及Cornell乘积指数2 440 mm/ms能够显著区分CH(阳性率分别为88%、85%和82%)和EH(阳性率分别为62%、60%和62%)(P0.01);Cornell乘积指数2 440 mm/ms(在CR组的阳性率(80%、75%)明显高于EH组(62%、40%)(P0.01)。结论:心电图Cornell电压指数及Cornell乘积指数可较好鉴别高血压病左室肥厚的不同几何构型。     

Endogenous ouabain and hemodynamic and left ventricular geometric patterns in essential hypertension

We sought to evaluate the relationships among circulating levels of an endogenous ouabain-like factor (EO) and systemic hemodynamics and left ventricular (LV) geometry in patients with recently diagnosed essential hypertension. We selected 92 never-treated patients with essential hypertension. Blood samples were drawn for estimation of plasma EO (radioimmunoassay) and subjects underwent echocardiographic examination to evaluate LV end-systolic and end-diastolic wall thickness and internal dimensions. LV volumes, stroke volume, cardiac output, total peripheral resistance, LV mass, and relative wall thickness were calculated, and all except the last parameter were indexed by body surface area. LV mass also was indexed by height. On the basis of the values of LV mass index (body surface area or height) and relative wall thickness, subjects were divided into groups with either normal geometry, concentric remodeling, concentric hypertrophy, or eccentric nondilated hypertrophy. In the study population as a whole, circulating EO levels were significantly and directly correlated with mean blood pressure (r = 0.21, P = .048), relative wall thickness (r = 0.34, P = .001), and total peripheral resistance index (r = 0.37, P = .0003). Plasma EO also was significantly and inversely correlated with LV end-diastolic volume index (r = -0.32, P = .002), stroke index (r = -0.34, P = .0009), and cardiac index (r = -0.35, P = .0007). In multiple regression analysis, plasma EO was an independent correlate of total peripheral resistance index, cardiac index, and relative wall thickness. Regardless of the indexation method used for LV mass, plasma EO was higher in patients with concentric remodeling than in those with either normal geometry or concentric hypertrophy. Plasma EO tended to be higher (indexation by body surface area) or was significantly higher (indexation by height) in subjects with concentric remodeling than in those with eccentric nondilated hypertrophy. Patients with concentric remodeling showed the highest total peripheral resistance index and the lowest cardiac index. Our data suggest that EO plays a role in regulating systemic hemodynamics and LV geometry in patients with essential hypertension.     

Atrial and brain natriuretic peptide and endothelin-1 concentration in patients with idiopathic arterial hypertension: the dependence on the selected morphological parameters

INTRODUCTION: The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH). METHODS: Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2 - control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis. RESULTS: A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH. CONCLUSIONS: Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important - especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.     

A new parameter of pulsed-wave tissue Doppler imaging: IVRa

Objective: We investigated how velocity of isovolumetric relaxation period on pulsed‐wave tissue Doppler trace (IVRa and IVRb) is affected by the left ventricular (LV) geometry changes. Methods: Two hundred cases without exclusion criteria were included in the study. Normal LV mass index (LVMI) and normal relative wall thickness (RWT) was assigned to group 1 (n = 72). Concentric remodeling (normal LVMI and increased RWT) was defined to group 2 (n = 25). Eccentric LV hypertrophy (LVH) (increased LVMI and normal RWT) was defined to group 3 (n = 62). And finally, concentric LVH (increased LVMI and increased RWT) was defined to group 4 (n = 41). Results: Patients with LVH (groups 3 and 4) were older than group 1 (P = 0.017 and 0.001). It was observed in the assessment of M‐mode ECHO parameters that the aortic valve diameter, aortic valve opening, LV end‐systolic diameter (LVESD), LV end‐diastolic diameter (LVEDD), and left atrium (LA) were higher in cases with eccentric LVH. It was shown that Ea velocity and Sa velocity time integral (Sa‐VTI) were decreased with LV geometry change. However, IVRa velocity and E/Ea were increased as LV geometry change. A positive correlation between IVRa velocity and LVMI (correlation ratio = 34%, P = 0.000) was found. Similarly, a positive correlation between IVRa velocity and RWT (correlation ratio = 17%, P = 0.025) was found. Conclusion: IVRa velocity exhibits a positive correlation with LV geometry changes indicating that IVRa velocity is affected by LV geometry like the other parameters influenced by LV geometry.     

早期原发性高血压左心室舒张功能的超声心动图评价

目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。