Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study
Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study
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DOI：
10.1016/j.jash.2013.08.005
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发表时间：
2014-01-01
影响因子：
--
通讯作者：
Oki, Takashi
中科院分区：
文献类型：
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作者：
Miyoshi, Hirokazu;Oishi, Yoshifumi;Oki, Takashi
众所周知，高血压和肥胖都会导致射血分数正常的心力衰竭。因此，阐明无症状肥胖伴高血压患者左心房（LA）-左心室（LV）相互作用进一步恶化的机制具有重要的临床意义。对134例无症状高血压患者进行常规超声心动图和二维斑点追踪超声心动图（2DSTE）检查。研究样本分为两组：非肥胖组（n = 80;体重指数[BMI] = 25 kg/m2）。肥胖组左室舒张末期内径、早期二尖瓣血流与二尖瓣环运动速度比值（E/e '）、左室收缩期峰值周向应变率、E/e'/左室收缩期峰值应变（S-LA）均大于对照组。在单变量分析中，BMI和E/e '/S-LA显著相关的变量中，多变量分析显示，BMI与所有高血压患者的舒张末期LV直径和收缩期LV径向应变峰值独立相关，年龄、收缩压、相对LV壁厚度、收缩期二尖瓣环运动速度（s'）峰值、收缩期LV径向应变峰值、和舒张早期左室纵向应变率峰值是肥胖患者E/e '/S-LA的独立预测因子，而非肥胖患者只有s'对E/e '/S-LA有影响。在高血压的情况下，LA-LV相互作用受损会随着肥胖而加速。使用2DSTE评估左心房和左心室功能，为心血管危险因素对无临床症状患者左心房和左心室功能的负面影响提供了额外信息。J Am Soc Hypertens 2014;8（1）：54-63。(C)2014年美国高血压学会。All rights reserved.
Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] = 25 kg/m(2)). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e'), peak systolic LV circumferential strain rate, and E/e'/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e'/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s'), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e'/S-LAs in the obese patients, whereas only s' contributes to the E/e'/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms. J Am Soc Hypertens 2014;8(1):54-63. (C) 2014 American Society of Hypertension. All rights reserved.