Effect of amlodipine combined with telmisartan or compound amiloride on plasma ET-1 concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy

Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride

Ultrasonic evaluation of the relationship between left ventricular hypertrophy or left ventricular geometry and endothelial function in patients with essential hypertension

Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia （DIRH） or nitroglycerin （DING） was detected using high-resolution ultrasonography. Results： DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH （4.36±2.54% vs 8.56 ± 1.87 %; P 〈 0.0001）. There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups （P 〉 0.05）. While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index （LVMI） correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure （r=-0.61, P 〈 0.0001; r=0.27, P 〈 0.05; r=0.31, P 〈 0.05, respectively）, a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion： Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.

The Correlation between Morning Blood Pressure Surge, Homocysteine and Left Ventricular Hypertrophy in Elderly Patients with Primary Hypertension

Objective: To investigate the correlation between morning blood pressure surge, homocysteine (Hcy) and left ventricular hypertrophy (LVH) in elderly patients with primary hypertension. Method: 215 cases of patients with hypertension from January 2015 to June 2016 were randomly selected from TianYou Hospital attached to WUST.Blood pressure was monitored 24 hours;according to the results, patients were divided into 81 cases of morning blood pressure surge group (study group) and 134 cases of non-morning blood pressure surge group (control group). Biochemical indicators of the two groups were measured, such as Hcy, Glu, blood lipid (TC, TG, LDL-C, HDL-C). The ventricular structure index (IVST, LVDD, LVPWT, LVMI) were measured by color doppler ultrasound.Result: 1) The IVST, LVDD, LVPWT and LVMI were significantly higher in study group than in control group (P 0.05), and the incidence of left ventricular hypertrophy (LVH) (74.1%) was significantly higher in study group than in control group (22.4%) (P 0.05). 2) There was no statistical difference in TC, TG, LDL-C and HDL-C between the two groups (P > 0.05). The serum levels of Hcy [(16.89 ± 5.84) mmol/L] in study group were significantly higher than those in control group [(10.88 ± 4.07) mmol/L] (P 0.05). 3) Multivariate logistic regression analysis showed that morning blood pressure surge and Hcy were the risk factors of left ventricular hypertrophy. Conclusion: In elderly patients with?hypertension, the higher the morning blood pressure surge and Hcy level, the more probability of left ventricular hypertrophy and the more obvious degree.

Plasma Norepinephrine and Hemorheology in Essential Hypertensive Patients with Different Patterns of Left Ventricular Hypertrophy

对80例不同类型高血压左室肥厚（LVH）患者的血浆去甲肾上腺素（NE）和血液流变学改变进行观察。结果显示，（1）向心性肥厚组（CH）高切变率下全血粘度（WBV230）显著升高；（2）不对称性室间隔肥厚组（ASH）血浆NE和收缩末期室壁应力（ESS）增高较明显；（3）多元回归分析显示，SBP，ESS和血浆NE是影响相对室壁厚度的重要因素。提示CH是一种对压力负荷过重而产生的代偿形式；ASH的形成除了负荷因素外血浆NE可能起更重要的作用。

Left ventricular hypertrophy amplifies the QT,and Tp-e intervals and the Tp-e/QT ratio of left chest ECG

Objective： To evaluate the changes in Tp-e interval （an interval from the peak to the end of the T wave）, QT interval and Tp-e/QT ratio of the body surface ECG in patients with left ventricular hypertrophy （LVH）. Methods： The Tp-e interval and QT interval were measured on body surface ECGs in 42 patients without either hypertension or LVH （control group）, 41 patients having hypertension but not LVH （non-LVH group）, and 38 patients with both hypertension and LVH （LVH group）. Results： The mean corrected QT （QTc） interval, and mean corrected Tp-e[T（p-e）c] interval were significantly longer in the LVH group （0.430±0.021s vs. 0.409±0.019s, p 〈 0.01; 0.098±0.013s vs. 0.088±0.011s, respectively） than those in the control group. The Tp-e/QT ratio was also amplified in LVH group （0.232± 0.028 vs.0.218± 0.027） （p 〈 0.05）. Conclusion： LVH increased the QT interval, Tp-e interval and Tp-e/QT ratio of the body surface ECG.

Effect of Salvia Miltiorrhiza Bge on Left Ventricular Hypertrophy and the Expression of Tumor Necrosis Factor-α in Spontaneously Hypertensive Rats

The effects of salvia miltiorrhiza Bge (SMB) on left ventricular hypertrophy (LVH) and the expression of tumor necrosis factor-α (TNF-α) in the left ventricle of spontaneously hypertensive rats and the action mechanism were investigated. Normal Wistar-kyoto (WKY) rats were used as negative control, and spontaneously hypertensive rats (SHR) were randomly assigned to receive pla- cebo or SMB. SMB (1 g/kg·d) was injected intraperitoneally for 12 weeks. Systolic blood pressure (SBP) and left ventricular mass index (LVMI) were measured. HE, VG and immunohistochemical staining combined with computed morphometry were employed to evaluate the cardiomyocyte size, diameter, the collagen volume fraction (CVF), perivascular circumferential area (PVCA), and tumor necrosis factor-α (TNF-α) expression in the left ventricular tissue. The results showed, as compared with WKY rats, the SBP, LVMI, cardiomyocyte size, diameter, CVF, PCVA, and TNF-α expression were increased markedly in the 20-week-old spontaneously hypertensive rats. SMB decreased LVMI (P<0.01), size of cardiomyocytes (P<0.01), collagen volume fraction (P<0.01), perivascular circum- ferential area (P<0.01), and TNF-α expression (P<0.01), but had no effect on SBP (P>0.05). It was suggested that chronic administration of SMB could inhibit and reverse the development of LVH in spontaneously hypertensive rats independent of BP. TNF-α may be involved in the reversal mecha- nism of LVH by SMB.

Effect of Xinjikang on left ventricular hypertrophy remodeling in hypertensive rats

Objective:To investigate the effects of Xinjikang on the left ventricular hypertrophy remodeling and myocardial activity in hypertension.Methods:Sixty Wistar rats were randomly divided into four groups.The pressure-loaded left ventricular hypertrophy model was established with abdominal aorta ligation method.Rats in A and B groups were intragastrically administered with physiological saline,while C and D groups were administered with Xinjikang and metoprolol,respectively.The changes in blood pressure.E/A ratio,myocardial pathological morphology,myocardial lipoperoxides and superoxide dismustase activity in four groups were observed and compared before and after treatment.Results:There were statistically significant differences in E/A ratio between C group after treatment and model group(P<0.05).while no difference was observed between A and D groups(P>0.05);after treatment the myocardial lipoperoxides and superoxide dismustase contents in C and D groups were improved significantly compared with model group(P<0.05).Conclusions:Xinjikang can improve myocardial injury,restore myocardial parenchyma and myocardial interstitial remodeling functions in hypertensive rats with the left ventricular hypertrophy.

Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study

Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P P P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P P P 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.

A Clinical Study of Reversing Left Ventricular Hypertrophy in Hypertensive Patients by Adalat

Fourteen outpatients (10 men, 4 women, mean age 52.6 yrs) suffered from essential hypertension complicated with left ventricular hypertrophy (LVH) detected by echocardiography were treated with Adalat 30 mg daily orally. After 3 months administration, casual high blood pressue was satisfactorily controlled. Both thickness of inter ventricular septum and left ventricular posterior wall were decreased (1.47 cm vs 1.34 cm P<0.01, 1.43 cm vs 1.32 cm P<0.01). Left ventricular mass (LVM) and left ventricular mass index (LVMI) calculated according to Devereux corrective formula were significantly reversed (279.4 g vs 247.4 g P<0.01, 162.7 g/m 2 vs 146.5 g/m 2 P<0.01). Meanwhile, cardiac performance was assessed, and the results demonstrated that Adalat could maintain left ventricular systolic function and improve left ventricular diastolic function which was resulted from regression of LVH. No side effects of Adalat were present in the study patients.

Correlation between IL-33/sST2 signaling pathway and patients with essential hypertensive left ventricular hypertrophy

Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with essential hypertensive left ventricular hypertrophy was further discussed.Methods:A total of 220 patients with essential hypertension treated in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Bengbu Medical College were enrolled as the experimental group.According to left ventricular mass index(LVMI),patients with essential hypertension were divided into the non-left ventricular hypertrophy group(NLVH,n=108 cases)and the left ventricular hypertrophy group(LVH,n=112 cases).We used ELISA to detect the serum levels of IL-33 and sST2,the expression levels of IL-33 in peripheral blood lymphocytes of the NLVH group and the LVH group(60 cases each)were detected by Western blot,and the relationship between IL-33 and LVMI,a marker of left ventricular hypertrophic condition,was analyzed by Pearson.The relationship between IL-33,sST2 and left ventricular hypertrophy in essential hypertension was studied.Results:Compared with the NLVH group,the expression levels of IL-33 and sST2 in the LVH group were significantly increased.The results of Western blot showed that the expression level of IL-33 in the LVH group(1.07±0.08)was higher than that in the NLVH group(0.63±0.05)(P<0.05).Pearson correlation analysis showed that IL-33 was positively correlated with LVMI,sST2 was positively correlated with LVMI.Conclusion:The levels of IL-33 and sST2 in serum and the expression levels of IL-33 protein in peripheral blood lymphocytes are significantly increased in patients with hypertensive left ventricular hypertrophy,and the occurrence and development of essential hypertensive left ventricular hypertrophy may be related to IL-33 and sST2.

Effect of Osteoprotegerin and XRCC3 Genes Polymorphisms with the Occurrence of Left Ventricular Hypertrophy in Hypertensive Patients

Background: High blood pressure is associated with adverse morphological and functional changes in the cardiovascular system, including left ventricular hypertrophy (LVH). Osteoprotegerin (OPG) is a member of the tumor necrosis factor receptor superfamily of cytokines. X-ray repair cross-complementing protein 3 (XRCC3) is involved in the repair pathway for double-strand breaks (DSBs). We assessed the association of osteoprotegerin and XRCC3 gene polymorphisms with the occurrence of left ventricular hypertrophy in hypertensive patients. Patients and methods: The study included 50 hypertensive patients: 25 with LVH (group A) and 25 without LVH (group B). All cases were subjected to complete history taking and clinical examination. ECG and echocardiography were done. LV mass was calculated to detect the presence or absence of LV hypertrophy. DNA was extracted from blood samples, and then, each DNA sample was amplified in PCRs, to detect osteoprotogrin and XRCC3 gene polymorphisms. Results: Mean age in the cases in group A is 63.12 years and in group B was 58.24 years with statistically significant difference between the two groups. The duration of the disease and SBP revealed statistically significant difference between the two groups. The LV mass index and E/A ratio revealed high statistically significant difference between the two groups. OPG sequence revealed no statistically significant difference between the two groups, but XRCC3 sequence revealed statistically significant difference. The age was a risk factor for LVH. Conclusion: Osteoprotogrin and XRCC3 genes polymorphism mutations may be associated with left ventricular hypertrophy in hypertensive patients.

Left Ventricular Hypertrophy and Predictive Factors among Congolese Hypertensive Patients

A cross-sectional study of hypertensive patients was carried out in Brazzaville between January 2011 and December 2013.?The objectives of the present study are to determine the different types of left ventricular hypertrophy (LVH)?and to identify the predictive factors of LVH. It included 556 hypertensive patients with LVH, characterized by left ventricular mass index (LVMI) > 135 g/m2?in men, and > 111 g/m2?in women. Patients’ sociodemographic data and echocardiographic parameters were gathered and analyzed. There were 342 males (61.5%) and 214 females (38.5%),?with?mean age 53.5 ± 11.5 years. The indications of the test were hypertension initial evaluation in 402 cases (72.3%), investigation of ischemic stroke in 62 cases (11.2%), heart failure in 58 cases (10.4%), dyspnea and chest pain in respectively 22 and 12 cases. Hypertension, old of 5.2 ± 4.5 years, was associated with overweight/obesity in 408 cases (73.4%), physical inactivity in 325 cases (58.5%), hypertension family history in 274 cases (49.3%), diabetes mellitus in 76 cases (13.7%), dyslipidemia in 63 cases (11.3%), tobacco use in 9 cases (1.6%). The prevalence of LVH was 49.4% and consisted into concentric LVH in 470 cases (84.5%), eccentric LVH in 70 cases (12.6%), and in 16 cases (2.9%),?it was a concentric left ventricular remodeling. Age, male gender, seniority of hypertension and treatment were predictive factors of LVH. The latter is the most predominant abnormality in the echocardiographic profile of Congolese hypertensive patients. Efficient management on hypertension will lead to reducing its morbidity and mortality.

趋化素和胱抑素C与原发性高血压左心室肥厚的相关性

目的观察血清胱抑素C(cystatin C,Cys C)、趋化素(Chemerin)对原发高血压患者继发左心室肥厚(left ventricular hypertrophy,LVH)的影响。方法选取2020年3月~2023年3月在承德市中心医院就诊的中老年高血压患者122例,根据超声心动检查分为左心室肥厚(LVH)组45例,无左心室肥厚(NLVH)组77例。另同期在本院检行超声心动检查无高血压的60名健康体检者作为健康对照组。比较患者病程、用药等一般临床资料、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、尿素氮(UN)、肌酐(Cr)、Cys C、Chemerin、同型半胱氨酸(homocysteine,Hcy)指标。采用Pearson进行相关分析,logistic回归分析左心室肥厚的影响因素。结果NLVH组和LVH组体质量指数(BMI)、TC、收缩后(SBP)、舒张后(DBP)、Cys C、Chemerin、Hcy水平均高于健康对照组,LVH组BMI、SBP、DBP、Cys C、Chemerin、Hcy水平高于NLVH组,差异均有统计学意义(P<0.05)。NLVH组吸烟人数和Cr水平高于健康对照组,差异有统计学意义(P<0.05),但与LVH组比较,差异无统计学意义(P>0.05)。Cys C、Chemerin与左心室质量指数呈正相关,相关系数分别为0.305、0.182。多因素回归分析显示,SBP、肥胖、Cys C、Chemerin、Hcy是影响LVH发生的独立风险因素。结论Cys C、Chemerin参与左心室肥厚的病理发展过程,是中老年原发性高血压患者继发左心室肥厚的独立危险因素。

原发性高血压患者冠状动脉周围脂肪衰减指数与左心室肥厚的相关性研究

目的探讨原发性高血压患者冠状动脉周围脂肪衰减指数(pFAI)与左心室肥厚(LVH)的关系。方法回顾性分析2021年12月至2022年12月在安徽医科大学第一附属医院住院的原发性高血压患者61例。根据彩色多普勒超声心动图检查结果,按左心室质量指数(LVMI)分为高血压不伴LVH组(非LVH组,34例)和伴LVH组(LVH组,27例)。通过回顾患者的病历记录和冠状动脉CT血管成像(CCTA)影像资料,统计所有患者的一般临床资料、检验结果、心电图、超声心动图参数和CCTA数据及pFAI进行分析。结果LVH组患者的冠状动脉左前降支(LAD)-脂肪衰减指数(FAI)[(-83.70±7.31)HU比(-88.29±7.00)HU,t=-2.483,P=0.016]、右冠状动脉(RCA)-FAI[(-82.78±10.41)HU比(-88.91±7.50)HU,t=-2.577,P=0.013]比非LVH组高,LVH组患者的冠状动脉回旋支(LCX)-FAI比非LVH组略高[(-82.15±6.48)HU比(-85.26±8.05)HU,t=-1.632,P=0.108];与LVMI的偏相关分析显示LCX-FAI(r=0.435,P<0.001)、RCA-FAI(r=0.339,P=0.011)呈正相关,LAD-FAI(r=0.259,P=0.057)有相关趋势。结论在原发性高血压患者中,pFAI与LVH呈正相关。

巨噬细胞移动抑制因子与原发性高血压患者左心室肥厚的关系

目的分析巨噬细胞移动抑制因子(MIF)与原发性高血压患者发生左心室肥厚(LVH)的关系,探讨MIF在原发性高血压患者发生左心室肥厚过程中的作用。方法以2019年1月至2020年9月期间在新疆医科大学第一附属医院心内科接受诊断和治疗的802例原发性高血压患者作为研究对象记录性别、民族、年龄、吸烟史、饮酒史、收缩压、舒张压、体质量指数、心脏超声参数等指标,通过ELISA方法检测血清MIF水平。根据Devereux公式计算左心室质量(LVM)和左心室质量指数(LVMI),并根据LVMI水平(男性>125 g/m^(2)、女性>120 g/m^(2))将患者分为左心室肥厚组(136例)和非肥厚组(666例)。绘制散点图并采用Sperman相关分析MIF与LVM和LVMI的关联。采用多因素logistic回归分析高血压患者发生LVH的影响因素;绘制ROC曲线,评估MIF预测高血压患者发生LVH的效能。结果肥厚组的MIF水平高于非肥厚组,差异具有统计学意义[124.77(79.05,141.58)ng/ml比69.07(51.76,88.08)ng/ml,P<0.05]。此外,肥厚组的男性比例、冠心病病史比例、年龄、高血压病程、收缩压水平均高于非肥厚组(P<0.05)。Sperman相关性分析结果显示,MIF与LVM、LVMI呈正相关(r分别为0.270、0.320)。多因素logistic回归分析结果表明,MIF(OR=1.029,95%CI 1.023~1.036,P<0.001)、收缩压(OR=1.013,95%CI 1.003~1.024,P=0.013)、男性(OR=1.997,95%CI 1.169~3.472,P=0.012)、饮酒(OR=0.356,95%CI 0.173~0.704,P=0.004)是高血压患者发生LVH的影响因素。ROC曲线结果显示,MIF预测高血压患者发生LVH的曲线下面积(AUC)为0.777(95%CI 0.725~0.829,P<0.001)。结论MIF与原发性高血压患者左心室肥厚存在关联,提示MIF可能参与高血压影响心脏功能的过程。

经胸超声心动图联合超声造影检测冠状动脉血流储备对高血压患者冠状动脉病变的预测价值

目的 探讨经胸超声心动图联合超声造影检测冠状动脉血流储备(CFR)对高血压患者冠状动脉病变的预测价值。方法 纳入伴有左心室肥厚(LVH)的高血压患者45例作为观察组,另纳入45例单纯高血压患者作为对照组。对所有患者开展经胸超声心动图联合超声造影检查,比较两组经胸超声心动图检查结果及造影检查结果。结果 两组患者的静息舒张期峰值血流速度(PDV)比较无差异(P>0.05);观察组的负荷PDV(47.34±14.98)cm/s及CFR(1.94±0.78)低于对照组的(67.78±15.57)cm/s、(2.83±1.82)(P<0.05)。观察组灌注量(7.02±2.91)L/min、曲线峰值强度(9.46±7.62)dB、曲线斜率(1.23±1.03)dB/s低于对照组的(9.64±3.34)L/min、(16.78±8.43)dB、(1.78±1.22)dB/s,灌注阳性率71.11%高于对照组的22.22%(P<0.05)。结论 经胸超声心动图联合超声造影可实现对CFR的评估,帮助了解高血压患者的冠状动脉病变情况,为冠状动脉病变的防治提供依据。

原发性高血压患者并发左心室肥厚的预测模型构建与验证

目的构建并验证原发性高血压患者并发左心室肥厚(left ventricular hypertrophy,LVH)的预测模型。方法选取2022年1月至12月于武汉市中心医院心血管内科住院治疗的332例原发性高血压患者为研究对象,经K折交叉验证划分为训练集与验证集。在训练集中采用LASSO回归、单因素及多因素Logistic回归模型分析原发性高血压患者并发LVH的独立影响因素,将其整合到预测模型中。通过受试者工作特征曲线、Hosmer-Lemeshow检验、校准曲线及决策曲线分别在训练集与验证集中判断预测模型的区分度、校准度、适用度,并绘制列线图将预测模型的结果可视化呈现。结果收缩压[OR=1.03,95%CI(1.01,1.05),P<0.001]为原发性高血压患者并发LVH的独立危险因素,而静息心率[OR=0.96,95%CI(0.93,0.98),P=0.002]、血清白蛋白[OR=0.90,95%CI(0.81,0.99),P=0.032]、血小板分布宽度[OR=0.36,95%CI(0.14,0.96),P=0.042]为原发性高血压并发LVH的保护因素。在训练集与验证集中,预测模型的区分度、校准度、适用度较好。结论本研究构建并验证了原发性高血压患者并发LVH的预测模型,为LVH的风险预测提供了直观且简便的工具。

组织瓣环运动位移评价心室肥厚患者左室收缩功能

目的探讨组织瓣环运动位移(TMAD)自动追踪技术定量评价心室肥厚患者左室收缩功能的应用价值。方法纳入60例心室肥厚患者,原发性高血压亚组30例,尿毒症亚组30例,纳入35例健康体检者作为对照组。应用二维斑点追踪技术自动获取心尖四腔心切面、心尖两腔心切面二尖瓣环四个位点TMAD值、左心室整体纵向应变(LVGLS)及左室整体圆周应变(LVGCS),应用Bland-Altman法检验TMAD参数一致性及绘制受试者工作特性(ROC)曲线评价TMAD参数的诊断效能。结果原发性高血压亚组和尿毒症亚组的收缩压(SBP)、舒张压(DBP)明显高于对照组(P<0.05);尿毒症亚组的心率(HR)高于原发性高血压亚组及对照组(P<0.05)。尿毒症亚组的TMAD参数及应变参数均明显低于对照组(P<0.05)。原发性高血压亚组的LVGLS、T-AP4sep、T-AP4mid%、T-AP2int、T-AP2ant及T-AP2mid%低于对照组(P<0.05)。ROC曲线结果显示,TMAD各参数对心室肥厚患者左室收缩功能降低具有中等预测价值。结论TMAD可以定量评价心室肥厚患者的左室收缩功能,且可重复性好。

原发性高血压患者血浆致动脉粥样硬化指数及血清脂蛋白相关磷脂酶A2水平与左心室肥厚的关系研究

背景高血压是当前临床上常见的慢性非传染性疾病,由于人口老龄化和人类生活方式的改变,全球高血压患病率呈上升趋势。长期血压增高会导致心、脑、肾、眼底等多种靶器官的损害,严重威胁人类健康,是全球疾病负担的主要原因。而左心室作为终末器官损伤的主要靶点,其结构改变也是许多心血管疾病发生、发展的病理基础。目的探讨原发性高血压患者血浆致动脉粥样硬化指数(AIP)及血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平与左心室肥厚(LVH)的关系。方法纳入2021年10月—2023年6月就诊于郑州大学第二附属医院心血管内科的原发性高血压患者167例为研究对象,收集患者基线资料,收集患者空腹肘静脉血检测生化指标,入院后24 h内进行超声心动图检查,计算左心室质量(LVM)、左心室质量指数(LVMI)。根据LVMI将患者分为非左心室肥厚组(NLVH组)87例、LVH组80例。采用Pearson相关性检验及Spearman秩相关分析探究血清Lp-PLA2水平及AIP与超声心动图参数的相关性。采用多因素Logistic回归分析探究高血压患者发生LVH的影响因素。绘制受试者工作特征曲线(ROC曲线)探究血清Lp-PLA2水平及AIP对高血压患者合并LVH的诊断价值,并计算ROC曲线下面积(AUC)。结果LVH组患者年龄、高血压病程、N末端B型尿钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、左心室后壁厚度(LVWPT)、室间隔厚度(IVST)、左心室舒张末期内径(LVEDd)、左心房收缩末期内径(LAESd)、Lp-PLA2水平、AIP、LVM及LVMI高于NLVH组(P<0.05)。相关性分析结果显示,LVMI与Lp-PLA2、AIP、NT-proBNP、hs-CRP、年龄、高血压病程呈正相关(P<0.05),LVWPT与Lp-PLA2、AIP、NT-proBNP、hs-CRP、高血压病程呈正相关(P<0.05),IVST与Lp-PLA2、AIP、hs-CRP、年龄、高血压病程呈正相关(P<0.05),LVEDd与Lp-PLA2、AIP、NT-proBNP、hs-CRP呈正相关(P<0.05)。多因素Logstic回归分析结果显示,hs-CRP升高(OR=1.249,95%CI=1.007~1.548,P=0.043)、NT-proBNP升高(OR=1.009,95%CI=1.002~1.017,P=0.011)、AIP升高(OR=14.557,95%CI=1.220~173.753,P=0.034)、Lp-PLA2升高(OR=1.042,95%CI=1.024~1.059,P<0.001)是高血压患者发生LVH的危险因素。ROC曲线结果显示,AIP、Lp-PLA2及联合检测诊断高血压合并LVH的AUC分别为0.649(95%CI=0.566~0.733)、0.780(95%CI=0.705~0.854)、0.804(95%CI=0.733~0.874)。结论血清Lp-PLA2水平及AIP值与左心室形态结构改变紧密相关,两者联合检测有助于高血压左心室肥厚的早期临床诊断,对临床诊疗具有指导意义。

EFFECT OF PERINDOPRIL AND METOPROLOL ON LEFT VENTRICULAR HYPERTROPHY AND PERFORMANCE IN ESSENTIAL HYPERTENSION

The effects of perindopril and metoprolol on left ventricular hypertrophy (LVH) and function were studied in 47 essential hypertensive patients with LVH. Previous antihypertensive drugs were discontinued for at least 2 weeks, after which patients were randomly divided into 2 groups. 25 subjects were treated with perindopril 4 to 8 mg once daily in the morning (Group A) and 22 subjects with metoprolol 25 to 62.5 mg twice daily (Group B). The subjects were evaluated before and after 4 and 8 weeks of treatment by use of echocardiography. Before treatment LV mass indexes (LVMI) of two groups were respectively 143.2 ± 21.3 g / m2 and 140.6 ± 23.7 g / m2 (P>0.05). In Group A, reduction of LVMI occurred after 4 weeks of treatment, and more pronounced after 8 weeks (from 143.2 ± 21.3 g / m2 to 126.6 ± 15.3 g / m2, P< 0.001), whereas reduction of LVMI occurred only after 8 weeks in Group B (from 140.6 ± 23.7 g / m2 to 133.4 ± 13.2 g / m2, P< 0.001). In addition, there was a significant (P<0.05) difference in LVMI between the two groups after 8 weeks. LV systolic function remained unchanged, whereas E / A increased significantly (P< 0.001) in two groups after 8 weeks. In conclusion, antihypertensive treatment with perindopril and metoprolol induced a significant regression of LVH associated with improvement in LV diastolic performance. Perindopril, compared with metoprolol, was more effective in reversing LVH.