INTRAMURAL MYOCARDIAL SHORTENING IN HYPERTENSIVE LEFT-VENTRICULAR HYPERTROPHY WITH NORMAL PUMP FUNCTION
INTRAMURAL MYOCARDIAL SHORTENING IN HYPERTENSIVE LEFT-VENTRICULAR HYPERTROPHY WITH NORMAL PUMP FUNCTION
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DOI：
10.1161/01.cir.89.1.122
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发表时间：
1994-01-01
期刊：
影响因子：
37.8
通讯作者：
AXEL, L
中科院分区：
文献类型：
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作者：
PALMON, LC;REICHEK, N;AXEL, L
背景 在高血压性左心室肥厚 (LVH) 中，内在心肌收缩功能可能正常或降低。磁共振标记可以描述体内壁内心肌缩短。方法和结果使用磁化空间调制，在 30 名 LVH（平均 LV 质量指数，142+/-41 g/m）和正常射血分数（平均，64+/-9%）的高血压受试者中获得标记的左心室磁共振图像。将 26 名受试者的圆周心肌缩短 (%S) 与 10 名正常受试者在心内膜、中壁和心外膜各最多 4 个短轴切片上获得的结果进行比较。同样，将 10 名受试者的基底、心室中部和心尖部位的中壁长轴缩短情况与 12 名正常志愿者的结果进行了比较。高血压受试者的周长 %S 降低。高血压受试者的心内膜平均缩短为 29+/-6%，而正常受试者的心内膜平均缩短为 44+/-6% (P=.0001)；中壁处为 20+/-6%，而中壁处为 30+/-6% (P=.0001)；心外膜为 13+/-5%，而心外膜为 21+/-5% (P=.0002)。然而，高血压受试者从心内膜到心外膜缩短百分比的透壁梯度与正常受试者平行。 LVH 中不存在周向 %S 中正常的基部到顶点梯度。与正常受试者相比，高血压受试者的周向 %S 显示出区域异质性，外侧壁最大，下壁最小。高血压受试者的纵向缩短也均匀降低：基础为 10+/-9%，而正常受试者为 21+/-6% (P=.0001)；中室为 14+/-8%，而中室为 18+/-3% (P=.03)；心尖部为 14+/-8%，而心尖部为 18+/-4% (P=.04)。 结论 在泵功能正常的高血压 LVH 中，壁内周向和纵向心肌缩短受到抑制。
Background In hypertensive left ventricular hypertrophy (LVH), intrinsic myocardial systolic function may be normal or depressed. Magnetic resonance tagging can depict intramural myocardial shortening in vivo.Methods and Results Tagged left ventricular magnetic resonance images were obtained in 30 hypertensive subjects with LVH (mean LV mass index, 142+/-41 g/m) and normal ejection fraction (mean, 64+/-9%) using spatial modulation of magnetization. In 26 subjects, circumferential myocardial shortening (%S) was compared with results obtained in 10 normal subjects at endocardium, midwall, and epicardium on up to 4 short-axis slices each. Similarly, in 10 subjects, midwall long-axis shortening at basal, midventricular, and apical sites was compared with results obtained in 12 normal volunteers. Circumferential %S was reduced in hypertensive subjects. Mean shortening was 29+/-6% at the endocardium in hypertensive subjects versus 44+/-6% in normal subjects (P=.0001); 20+/-6% at the midwall versus 30+/-6% (P=.0001); and 13+/-5% at the epicardium versus 21+/-5% (P=.0002). However, the transmural gradient in percent shortening from endocardium to epicardium in hypertensive subjects paralleled that in normal subjects. The normal base-to-apex gradient in circumferential %S was absent in LVH. In contrast to normal subjects, circumferential %S showed regional heterogeneity in hypertensive subjects, being maximal in the lateral wall and least in the inferior wall. Longitudinal shortening was also uniformly depressed in hypertensive subjects: 10+/-9% at the base versus 21+/-6% in normal subjects (P=.0001); 14+/-8% at the midventricle versus 18+/-3% (P=.03); and 14+/-8% at the apex versus 18+/-4% (P=.04).Conclusions In hypertensive LVH with normal pump function, intramural circumferential and longitudinal myocardial shortening are depressed.