Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data
Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data
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使用国际指南和 EMINCA 数据中的阈值对高血压患者进行左心室和心房重构
DOI：
10.1093/ehjci/jeab216
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发表时间：
2022-01-24
影响因子：
6.2
通讯作者：
Zhang, Mei
中科院分区：
文献类型：
--
作者：
Sheng, Yuanyuan;Li, Mengmeng;Zhang, Mei
目的采用国际指南定义的不同阈值和中国正常成人超声心动图测量（EMINCA）研究的数据以及不同的识别方法，探讨高血压患者左心室（LV）和左心房（LA）重构的发生率差异。方法和结果采用二维超声心动图测量了612例EMINCA研究人群中健康志愿者和306例年龄和性别匹配的中国成年高血压患者的左室质量（LVM）、相对室壁厚度和左室容积（LAV）。左心室质量和左心房容积分别以体表面积（BSA）、身高（2）（.）(7)，高度（1）（.）(7)指南或研究者推荐的身高（2）。使用以前报道的方法，左心室几何形状分为正常几何形状，向心性重塑，离心性肥大，向心性肥大。采用不同阈值和指数化方法比较高血压患者左室肥厚（LVH）的发生率和左室构型。指南和健康志愿者的超声心动图阈值显示出显著差异，特别是根据身高指数（2）和身高指数（1.7）的左心房体积，这导致健康志愿者的左心房扩张和左心室肥厚的患病率显著降低。当左心室质量指数为BSA、身高（1.7）和身高（2）（，7）时，健康志愿者阈值的左心室几何图形异常的总比例显著低于指南。结论使用指南推荐的超声心动图阈值和索引方法可能导致中国高血压患者左房扩张和左室几何结构异常的严重误诊，需要基于种族特异性正常超声心动图参考值的阈值和准确的索引算法。
Aims To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. Methods and results LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height(2)(.)(7), height(1)(.)(7), and height(2) recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height(2) and for LVM indexed to height(1.7), which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height(1.7), and height(2)(,7). Conclusion Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.