PATTERNS OF LEFT-VENTRICULAR HYPERTROPHY AND GEOMETRIC REMODELING IN ESSENTIAL-HYPERTENSION
PATTERNS OF LEFT-VENTRICULAR HYPERTROPHY AND GEOMETRIC REMODELING IN ESSENTIAL-HYPERTENSION
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DOI：
10.1016/0735-1097(92)90617-v
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发表时间：
1992-06-01
影响因子：
24
通讯作者：
LARAGH, JH
中科院分区：
文献类型：
--
作者：
GANAU, A;DEVEREUX, RB;LARAGH, JH
应用二维和M型超声心动图研究了165例原发性高血压患者和125例年龄和性别匹配的正常成人的左室几何适应性频谱。在高血压患者中，52%的左室重量指数和相对室壁厚度正常，而13%的左室重量正常的相对室壁厚度增加（“同心重塑”），27%的患者肿块增大，相对壁厚正常（离心性肥大），只有8%有“典型”的高血压向心性肥大（两个变量均增加）。全身血液动力学改变心室几何形状，在向心性重塑和肥大组中外周阻力最高，心脏指数在离心性肥厚组高于正常，在向心性重构组低于正常。左室短轴/长轴比值与每搏输出量呈正相关（r = 0.45，p < 0.001），向心性重构者腔形多为椭圆形，离心性肥厚者腔形多为球形。向心性重构中左心室质量的正常性似乎反映了压力超负荷效应的体积“欠载”的抵消，而离心性肥大与伴随的压力和体积超负荷相关。因此，动脉高压与与全身血流动力学和心室负荷相匹配的心脏几何适应谱相关。在未经治疗的高血压患者中，向心性左心室重塑和离心性肥大比典型的向心性肥大更常见。
The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables).Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was supernormal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p < 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.