Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study.
Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study.
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DOI：
10.1016/j.jcmg.2015.08.007
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
O'Regan DP
中科院分区：
文献类型：
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作者：
de Marvao A;Dawes TJ;Shi W;Durighel G;Rueckert D;Cook SA;O'Regan DP
本研究使用高分辨率三维心脏磁共振来定义未用药队列中与收缩压（SBP）升高相关的左心室（LV）解剖和功能特性。左心室肥大和重塑是对血流动力学应激的反应，但对这些表型变化在普通人群中是如何启动的知之甚少。在这项研究中，1,258名志愿者（54%为女性，平均年龄40.6 ± 12.8岁）没有自我报告的心血管疾病，接受了三维心脏磁共振结合计算建模。使用经体表面积、性别、种族、年龄和多重检验校正的三维回归模型分析SBP与室壁厚度（WT）、相对WT、收缩末期室壁应力（WS）和室壁增厚分数之间的关系。确定了LV模型中显著相关的点（p < 0.05），并将与SBP的关系报告为平均β系数。收缩压与室间隔和前壁的不对称向心性肥厚性适应之间存在连续的关系，这与室壁应力的正常化有关。在侧壁，随着收缩压的升高，壁应力的增加并没有被相称的肥大关系所平衡。在血压正常者中，SBP与间隔和前壁的WT（β = 0.09）和相对WT（β = 0.07）呈正相关，并且这种区域性肥大关系在高血压前期（β = 0.10）和高血压患者（β = 0.30）中逐渐增强。这些结果表明，高血压心脏表型的前体可以追溯到健康的血压正常的成年人，并在低风险人群中，左室重构和SBP之间存在独立和连续的关系。这些适应性改变表现出明显的区域性变化，室间隔向心性肥厚和外侧壁离心性肥厚，这对传统的左室重塑分类提出了挑战。
This study used high-resolution 3-dimensional cardiac magnetic resonance to define the anatomical and functional left ventricular (LV) properties associated with increasing systolic blood pressure (SBP) in a drug-naïve cohort. LV hypertrophy and remodeling occur in response to hemodynamic stress but little is known about how these phenotypic changes are initiated in the general population. In this study, 1,258 volunteers (54% women, mean age 40.6 ± 12.8 years) without self-reported cardiovascular disease underwent 3-dimensional cardiac magnetic resonance combined with computational modeling. The relationship between SBP and wall thickness (WT), relative WT, end-systolic wall stress (WS), and fractional wall thickening were analyzed using 3-dimensional regression models adjusted for body surface area, sex, race, age, and multiple testing. Significantly associated points in the LV model (p < 0.05) were identified and the relationship with SBP reported as mean β coefficients. There was a continuous relationship between SBP and asymmetric concentric hypertrophic adaptation of the septum and anterior wall that was associated with normalization of wall stress. In the lateral wall an increase in wall stress with rising SBP was not balanced by a commensurate hypertrophic relationship. In normotensives, SBP was positively associated with WT (β = 0.09) and relative WT (β = 0.07) in the septal and anterior walls, and this regional hypertrophic relationship was progressively stronger among pre-hypertensives (β = 0.10) and hypertensives (β = 0.30). These findings show that the precursors of the hypertensive heart phenotype can be traced to healthy normotensive adults and that an independent and continuous relationship exists between adverse LV remodeling and SBP in a low-risk population. These adaptations show distinct regional variations with concentric hypertrophy of the septum and eccentric hypertrophy of the lateral wall, which challenge conventional classifications of LV remodeling.