ASSESSMENT OF LEFT-VENTRICULAR FUNCTION BY THE MIDWALL FRACTIONAL SHORTENING END-SYSTOLIC STRESS RELATION IN HUMAN HYPERTENSION
ASSESSMENT OF LEFT-VENTRICULAR FUNCTION BY THE MIDWALL FRACTIONAL SHORTENING END-SYSTOLIC STRESS RELATION IN HUMAN HYPERTENSION
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DOI：
10.1016/0735-1097(94)90390-5
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发表时间：
1994-05-01
影响因子：
24
通讯作者：
LARAGH, JH
中科院分区：
文献类型：
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作者：
DESIMONE, G;DEVEREUX, RB;LARAGH, JH
目标.本研究通过使用生理学上合适的室壁中间缩短/收缩末期应力关系来检测相对中度高血压患者的左心室功能。据报道，高血压患者的左室功能超常，可能是由于与平均左室收缩末期应力不匹配的内收缩而不是室壁中段缩短所致。从一个庞大的城市就业人口中抽取了474例高血压患者（女性150例，男性324例）和140例正常人（女性68例，男性72例）。正常人的超声心动图内收缩率和室壁中部缩短率与收缩末期应力呈负相关（p < 0.0001），用于计算高血压患者的内收缩率和室壁中部缩短率与预测值的比值。考虑到收缩期中壁的心外膜移位，从椭圆模型计算中壁缩短。在高血压患者中使用室壁中部缩短分数使功能高于正常值第95百分位数的患者比例从22%降至4%（p < 0.0001），缩短分数占预测值的百分比为107% 001对正常血压对照受试者中的100%）至95%（p < 0.0001; p < 0.001对正常血压对照受试者中的101%）。16%的高血压患者室壁中膜缩短率低于正常值的第5百分位数，而内膜缩短率为2%（p < 0.0001）：他们往往比其他高血压患者年龄大，并有向心性左心室肥厚。在高血压患者中，向心性左室肥厚或重构者的室壁中膜缩短率低于收缩末期应力预测值（p < 0.0001）。使用生理学上更合适的室壁中部缩短/收缩末期应力关系1）显著降低了高血压受试者中被确定为具有高内皮素左心室功能的比例; 2）确定了大量左心室功能降低的患者亚组，这些患者具有左心室同心几何形状，这是一种与高心血管风险相关的模式。
Objectives. This study examined left ventricular performance in relatively unselected hypertensive patients by use of physiologically appropriate midwall shortening/end-systolic stress relations.Background. Supranormal left ventricular function has been reported in hypertensive patients, possibly due to an artifact of mismatching endocardial rather than midwall fractional shortening to mean left ventricular end-systolic stress.Methods. Samples of 474 hypertensive patients (150 women, 324 men) and 140 normal subjects (68 women, 72 men) were drawn from a large urban employed population. The inverse relations (p < 0.0001) of both echocardiographic endocardial and midwall fractional shortening to end-systolic stress in normal subjects were used to calculate the ratios of observed to predicted endocardial and midwall fractional shortening in hypertensive patients. Midwall shortening was calculated from an elliptic model, taking into account the epicardial migration of the midwall during systole.Results. Use of midwall fractional shortening in hypertensive patients reduced the proportion of patients with function above the 95th percentile of normal from 22% to 4% (p < 0.0001) and fractional shortening as a percent of predicted from 107% (p < 0.001 vs. 100% in normotensive control subjects) to 95% (p < 0.0001; p < 0.001 vs. 101% in normotensive control subjects). Midwall shortening was below the 5th percentile of normal in 16% of hypertensive patients instead of 2% with endocardial shortening (p < 0.0001): They tended to be older than other hypertensive patients and had concentric left ventricular hypertrophy. Among hypertensive patients, those with concentric left ventricular hypertrophy or remodeling had reduced midwall shortening as a percent of predicted from end-systolic stress (p < 0.0001).Conclusions. Use of the physiologically more appropriate midwall shortening/end-systolic stress relation 1) markedly reduces the proportion of hypertensive subjects identified as having high endocardial left ventricular function; and 2) identifies a substantial subgroup of patients with reduced left ventricular function who have concentric geometry of the left ventricle, a pattern associated with high cardiovascular risk.