Left ventricular hypertrophy in hypertension: Stimuli, patterns, and consequences
Left ventricular hypertrophy in hypertension: Stimuli, patterns, and consequences
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DOI：
10.1291/hypres.22.1
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发表时间：
1999-03-01
期刊：
影响因子：
--
通讯作者：
Roman, MJ
中科院分区：
文献类型：
--
作者：
Devereux, RB;Roman, MJ
儿童期左心室（LV）大小与身体大小密切相关，而成年期LV质量越来越受肥胖、高血压、心脏容量负荷水平和LV心肌收缩力水平的影响。最近，已经确定了糖尿病、动脉结构和功能以及未知基因与较高LV质量的其他独立关联;血管紧张素II和胰岛素也被认为是LV肥大的附加刺激。考虑到LV质量水平和LV壁厚/腔室半径比（相对壁厚），确定了LV适应高血压的四种不同几何模式，包括向心性LV肥大（质量和壁厚增加）、离心性肥大（质量增加，相对壁厚正常）、向心性重塑（相对壁厚增加，质量正常）和正常LV几何形状。向心性肥厚与特别高的动脉压相关，而离心性肥厚与肥胖和升高的容量负荷相关。许多研究表明，LV质量增加可预测心血管事件和死亡，而与所有常规风险因素无关;最初的研究还确定了低LV中壁功能和高相对壁厚度的不利影响，先锋研究强烈表明，逆转左心室肥大与改善预后有关。
Left ventricular (LV) size in childhood closely parallels body size, whereas in adulthood LV mass is increasingly affected by effects of obesity, hypertension, the level of cardiac volume load, and the level of LV myocardial contractility. Recently, additional independent associations of diabetes, arterial structure and function and as yet unknown genes with higher LV mass have been defined; angiotensin II and insulin have also been suggested to he additive stimuli to LV hypertrophy. Consideration of the level of LV mass and of the LV wall thickness/chamber radius ratio (relative wall thickness) has identified four different geometric patterns of LV adaptation to hypertension, including concentric LV hypertrophy (increased mass and wall thickness), eccentric hypertrophy (increased mass, normal relative wall thickness), concentric remodeling (increased relative wall thickness with normal mass) and normal LV geometry. Concentric hypertrophy is associated with especially high arterial pressure while eccentric hypertrophy is associated with obesity and elevated volume load, Numerous studies show that increased LV mass predicts cardiovascular events and death independently of all conventional risk factors; initial studies have also identified adverse implications of low LV midwall function and high relative wall thickness, Pioneer studies strongly suggest that reversal of LV hypertrophy is associated with an improved prognosis.