Changes of left ventricular remodeling due to increased afterload in patients with essential hypertension
Changes of left ventricular remodeling due to increased afterload in patients with essential hypertension
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原发性高血压患者后负荷增加导致左心室重构的变化
DOI：
10.1016/j.ijcard.2022.08.050
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发表时间：
2022
期刊：
影响因子：
3.5
通讯作者：
Ikeda S.
中科院分区：
文献类型：
--
作者：
Hamada M;Ogimoto A;Otani T;Ohshima K;Kono T;Watanabe Y;Tasaka T;Ikeda S.
背景原发性高血压（essential hypertension，EHT）发病初期是否存在后负荷不匹配尚不清楚.此外，高血压患者收缩功能保留和降低之间的临界左心室肥厚（LVH）也不清楚。因此，我们的目的是澄清这些points. MethodsForty五个正常对照组（NCS）和140 EHT患者参加。EHT患者分为三组：I组，无LVH（n= 37）; II组，LVH（n= 80）; III组，LVH和LV心力衰竭（LVHF）（n= 23）。常规心电图和超声心动图参数，V5 R/V6 R比值，相对壁厚（RWT），左室质量（LVM）指数，和收缩期峰值室壁应力（PSWS.ResultsIn组I，左室收缩功能得到保留，尽管增加PSWS。II组LVH进展，但左室收缩功能正常。在69%的组II和100%的组III中观察到负T波。NCS组、I组和II组RWT与左心室质量指数呈显著相关（r2= 0.545，P < 0.0001），而III组RWT与左心室质量指数无相关性。III组由于前负荷储备耗尽引起的V5 R/V6 R比值降低、左室舒张末期内径增大和左室收缩功能障碍，导致后负荷不匹配。组II和组III的左心室质量指数的界限约为180 g/m2。结论组I未出现后负荷不匹配，组III由于前负荷储备耗尽而出现后负荷不匹配。
BackgroundIt is unclear whether afterload mismatch occurs during the initial stage of essential hypertension (EHT). Additionally, critical left ventricular hypertrophy (LVH) between preserved and reduced systolic functions in hypertension is also unclear. Thus, we aimed to clarify these points.MethodsForty-five normal control subjects (NCS) and 140 EHT patients participated. EHT patients were subdivided into three groups: group I, without LVH (n= 37); group II, with LVH (n= 80); and group III, with LVH and LV heart failure (LVHF) (n= 23). Routine electrocardiographic and echocardiographic parameters, V5R/V6R ratio, relative wall thickness (RWT), LV mass (LVM) index, and peak systolic wall stress (PSWS) were measured.ResultsIn group I, LV systolic functions were preserved despite the increase of PSWS. In group II, LVH advanced, but LV systolic functions remained normal. A negative T-wave was observed in 69% of group II and 100% of group III. A significant correlation between RWT and LVM index was seen in NCS and groups I and II (r2= 0.545,P< 0.0001) but not in group III. Afterload mismatch occurred in group III due to the decrease in V5R/V6R ratio, the increase of LV end-diastolic dimension, and the LV systolic dysfunctions, which are caused by exhaustion of preload reserve. The boundary of the LVM index between groups II and III was approximately 180 g/m2.ConclusionAfterload mismatch did not occur in group I, but it was observed in group III due to the exhaustion of preload reserve.