Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography
Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography
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DOI：
10.1136/hrt.2009.185181
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发表时间：
2010-06-01
期刊：
影响因子：
5.7
通讯作者：
Sanderson, John E.
中科院分区：
文献类型：
--
作者：
Tan, Yu Ting;Wenzelburger, Frauke;Sanderson, John E.
目的：本研究验证了一种假设，即高血压治疗后血压控制良好、无心室肥厚且静息超声心动图正常的患者，可能只有在运动时才会出现明显的心室功能异常，并导致运动性呼吸困难的症状。方法对血压经药物控制、超声心动图基线正常的高血压患者进行心肺运动试验，测定其最大耗氧量（VO(2max)），然后进行休息和仰卧下运动超声心动图（标准、组织多普勒和斑点跟踪）。结果30例高血压患者（平均年龄71+/-8岁，女性18例）和22例年龄匹配的健康对照（70+/-6岁，女性16例）均有足够质量的休息和运动图像供分析。两组在休息时的标准超声心动图结果相似。运动时，与健康对照组相比，患者收缩纵向功能降低（储备指数0.97+/-1.34 vs 2.32+/-1.24, p = 0.001），早期解扭延迟（20.4+/-7.6 vs 30.6+/-7.8%, p = 0.001），心室吸力降低（速度传播10.6+/-10.9 vs 24.5+/-12.2 m/s, p < 0.001），这与VO（2max）显著降低相关。结论经静息超声心动图检查的高血压患者在运动时可出现广泛的左心室收缩和舒张功能不全并伴有运动受限。正常的静息超声心动图不能排除运动中可能导致症状的显著功能异常的存在。
Objectives This study tests the hypothesis that patients with treated hypertension with well-controlled blood pressure, without ventricular hypertrophy and normal resting echocardiography, may have abnormalities of ventricular function that are apparent only on exercise and contribute to symptoms of exertional dyspnoea.Methods Patients with hypertension with well-controlled blood pressure on medication and normal baseline echocardiography underwent cardiopulmonary exercise testing to determine their peak oxygen consumption (VO(2max)), followed by rest and submaxinal supine exercise echocardiography (standard, tissue Doppler and speckle tracking).Results 30 patients with treated hypertension with a history of exertional dyspnoea (mean age 71+/-8 years; 18 women) and 22 age-matched healthy controls (70+/-6 years; 16 women) had rest and exercise images of sufficient quality for analysis. Both groups had comparable standard echocardiographic findings at rest. On exercise, the patients had reduced systolic longitudinal function (reserve index 0.97+/-1.34 vs 2.32+/-1.24, p = 0.001), delayed early untwisting (20.4+/-7.6 vs 30.6+/-7.8%, p = 0.001) and reduced ventricular suction (velocity propagation 10.6+/-10.9 vs 24.5+/-12.2 m/s, p < 0.001) compared with healthy controls, which correlated with significantly reduced VO(2max).Conclusion Patients with treated hypertension with normal resting echocardiography can have exercise limitation associated with widespread systolic and diastolic left ventricular dysfunction on exercise. Normal resting echocardiography does not preclude the presence of significant functional abnormalities on exercise that can contribute to symptoms.