老年代谢综合征患者脉压与心血管重塑的关系

目的探讨老年代谢综合征（MS）患者脉压（PP）与心血管重构（颈动脉肥厚及左室肥厚）的关系。方法用超声检测76例MS患者和51例非MS患者的颈动脉内膜中层厚度（IMT）及左室质量指数（LVMI），并分析MS患者的颈动脉肥厚、左室肥厚与PP的关系。结果（1）2组患者在血脂、血糖、体质量指数、PP、IMT及LVMI间差异均有统计学意义（P〈0．05或P〈0．01）；（2）在MS组中，患者PP增高则颈动脉IMT及LVMI也增加，而颈动脉肥厚及左室肥厚组的PP也明显增高（P〈0．01）。结论MS患者脉压增高与心血管重塑密切相关。     

老年高血压病患者24 h 动态脉压与左室结构及功能变化的相关性研究

目的探讨老年高血压病患者24h动态脉压（24hPP）与左室结构及功能变化的相关性。方法对145例老年高血压病患者进行动态血压监测和超声心动图检查。将24hPP≥60mmHg的患者88例列为A组,24hPP〈60mmHg的患者57例列为B组,分别测量两组患者室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDD）,计算左室质量指数（LVMI）、左室射血分数（LVEF）及E／A,进行对比分析。结果A组患者LVMI及影响LVMI的3大因素（IVST,LVPWT,LVEDD）均明显高于B组（均P〈0．01）,显示随着脉压增大,出现明显的左心室肥厚;三型肥厚组患者的24hPP均高于无肥厚组;以扩张性肥厚组最显著。A组患者EF及E／A均低于B组,显示随着脉压增大,左室收缩舒张功能减退,以舒张功能受损更显著（P〈0．01）。结论24hPP增高是老年高血压病患者左室肥厚及心功能减退的重要危险因素。     

老年高血压患者动态脉压与左心室肥厚的关系

目的：探讨动态脉压与老年高血压病左心室肥厚的关系。方法：选择本院疗养员血压相对稳定（不停用原有的降压治疗措施）老年高血压患者155例，进行24小时动态血压监测及超声心动图检查，根据动态血压、脉压以及是否伴有左心室肥厚进行分组及统计学比较。结果：（1）随着脉压的增大，左室重量指数LVMI、24小时平均心率（24hHR）均有显著差异（P均〈0．05）；（2）相同脉压下，不管血压控制如何，LVMI无显著性差异；（3）左室肥厚组的动态脉压、收缩压及24h心率较非肥厚组均有显著差异（P均〈0．05）。结论：动态脉压的增大，是老年高血压患者左心室肥厚的危险因素。     

原发性高血压24小时脉压与左心室肥厚

目的：探讨原发性高血压患者脉压与左心室肥厚的关系。方法：97例原发性高血压患者按脉压高低被分为≤60mmHg和〉60mmHg两组。超声心动图测量舒张末期室间隔厚度、舒张末期左心室内径、舒张末期左心室后壁厚度。求出左心室质量指数（LVMI）。结果：高脉压组年龄较大．LVMI显著高于低脉压组[（135．3±23．5：（115．7±25．2）,P〈0．01]。结论：24h脉压高者更易发生左心室肥厚。     

原发性高血压左室肥厚患者心率振荡现象及临床意义

目的探讨原发性高血压合并左心室肥厚（LVH）患者心率振荡现象（HRT）及临床意义。方法人选276例原发性高血压患者，均进行心脏彩超检查及24h心电（Holter）记录，计算左心室重量、左心室重量指数（LVMI）、震荡初始（TO）及震荡斜率（偈）。以LVMI男性〉125g／m2．女性〉120g／m。和（或）室间隔厚度（IVST）〉12mm作为左室肥厚（LVH）标准，分为LVH组及左室正常组。结果LVH组TO及TS分别为（1．19±0．84）％及（4．23±0．85）ms／RR，左室正常组分别为（-0．54±0．86）％及（6．81±1．22）ms／RR，两组比较差异有统计学意义，P〈0．01。LVH组异常TO及偈比率与左室正常组比较，差异有统计学意义（P〈0．01）。TO与左室射血分数（LVEF）、左室舒张末期内径（LVEDD）及LVMI显著相关，P〈0．05。TS与LVEF、IVST显著相关，P〈0．05；与LVEDD及LVMI显著相关，P〈0．01。结论原发性高血压伴LVH患者的HRT明显减弱，提示高血压合并LVH时，自主神经功能受损加重。     

原发性高血压患者动态脉压与颈动脉粥样硬化的关系

根据动态全天平均脉压将171例原发性高血压患者分为脉压40～60mmHg组和〉60mmHg组，采用超声检测患者颈动脉内膜中层厚度、血管内径及斑块发生率，以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果脉压〉60mmHg组患者颈总动脉内径、颈总动脉最大内膜中层厚度、颈动脉斑块发生率明显高于脉压为40—60mmHg组（P〈0．01）。患者平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关（P〈0．01），而平均舒张压与颈总动脉最大内膜中层厚度呈负相关（P〈0．05）。认为脉压增加可使颈动脉粥样硬化性病变的患病率增加。     

24 h平均脉压和诊室脉压对高血压左室结构的影响

检测300例轻、中度高血压患者的诊室脉压（CPP）、24h动态血压和超声心动图，根据24h平均脉压（24hPP）、CPP水平分别分为A、B、C、D四组；根据左室重量指数（LVMI）分为左室肥厚（LVH）组和无LVH组，对不同水平24hPP和CPP所对应的LVMI作直线相关分析。结果显示，24hPP和CPP与LVMI直线相关分析均有显著相关性（P〈0．01），24hPP与LVMI的相关性明显强于CPP。提示高血压患者脉压与LVH有密切关系，24hPP更能反映高血压靶器官损害程度。     

冠心病颈动脉内膜中层厚度与左心功能的相关性研究

目的探讨冠心病患者颈动脉内膜中层厚度及颈动脉斑块发生率与左心功能和结构的相关性。方法对70例冠心病患者行颈动脉超声检查测量颈总动脉内膜中层厚度（CCA—IMT）、颈总动脉内径及颈动脉斑块。依据颈总动脉内膜中层厚度厚度将患者分成两组：CCA—IMT〈1mm为正常组,39例;CCA-IMT≥1mam为增厚组,31例。两组患者均行超声心动图检查,分别测量室间隔、左室侧壁及左室下壁的组织多普勒Tei指数（TDI—Tei）和脉冲多普勒Tei指数（PD—Tei）、左室壁厚度、心腔大小,计算左室射血分数。抽取外周静脉血检测血脂及纤维蛋白原水平。结果室间隔TDI-Tei及平均TDI-Tei在两组间比较差异有统计学意义（P〈0．01）。增厚组粥样斑块发生率明显高于正常组（P〈0．05）。年龄、脂蛋白a水平在两组间比较差异有统计学意义（P〈0．05）。PD-Tei指数与下壁、侧壁及平均TDI—Tei指数存在正相关（r分别为0．39、0．40及0．51,P均〈0．05）。结论早期超声检测冠心病患者颈动脉内膜中层厚度,有助于预测患者左心功能的改变。     

缬沙坦对原发性高血压心血管重构的干预

目的：探讨缬沙坦对原发性高血压患者左心室肥厚及血管壁肥厚的影响。方法：入选原发性轻、中度高血压（EH）伴左心室肥厚（LVH）病人48例，正常血压对照（NT）组48例，EH组给予缬沙坦80～160mg／d，治疗40周，治疗前后检测左室重量指数（LVMI），颈总动脉内膜中层厚度（IMT）。结果：EH组病人LVMI、IMT较对照组显著增厚（P〈0．01），缬沙坦治疗后LVMI、IMT显著减少（P〈0．01）。结论：EH伴左心室肥厚的病人同时存在颈总动脉壁肥厚，缬沙坦能逆转高血压心脏及血管的重构。     

高敏C反应蛋白与高血压左室肥厚及颈动脉粥样硬化的相关性研究

目的探讨高敏c反应蛋白（hs—CRP）与高血压左室肥厚（LVH）及颈动脉粥样硬化之间的关系。方法将入选的187例未经治疗的1～2级原发性高血压（EH）患者分为颈动脉正常组、颈总动脉IMT增厚组和颈动脉斑块组。采用胶乳免疫增强比浊法测定血清hs—CRP,行颈动脉超声检查测量颈总动脉内中膜厚度（IMT）,观察有无颈动脉斑块形成,从而判断有无颈动脉粥样硬化,分析血清hs—CRP与颈动脉粥样硬化、颈总动脉IMT、颈动脉斑块形成之间的关系。同时行心脏超声检查,根据左室质量指数（LVMI）将高血压患者分为LYH组与无LYH组。结果①颈动脉斑块组和颈动脉正常组血清hs—CRP分别为（6．34±1．35）mg／L和（2．34±0．53）mg／L,LVMl分别为（138．6±16．8）g／m。和（105．5±8．5）g／m2,颈动脉斑块组血清hs—CRP、LVMI均显著高于颈动脉正常组（P〈0．05）。②LVH组和NLVH组血清hs—CRP分别为（6．42±3．53）mg／L和（2．75±1．08）mg／L,IMT水平分别为（2．89±0．46）mm和（0．72±0．23）mm,LVH组血清hs—CRP、IMT均高于NLVH组（P〈0．01,P〈0．05）。相关分析表明,hs—CRP与LVMI及IMT均呈直线正相关（r=0．58,P〈0．05;r=0．53,P〈O．05）。结论血清hs—CRP与LVMI、IMT均密切相关,表明hs—CRP参与了高血压的发生发展,并且可能在高血压心血管重构过程中起到了至关重要的作用。     

维持性血液透析患者颈动脉硬化与左心室肥厚的关系

目的 研究维持性血液透析患者颈动脉硬化程度与左心室肥厚的关系.方法 收集36例维持性血液透析患者的一般临床资料及透析前的C反应蛋白等生物化学指标,应用彩色多普勒超声仪检测双侧颈总动脉、颈动脉分叉处及颈内动脉斑块、颈动脉内膜中膜厚度等,并用超声心动图测定左心室功能及肥厚指标,并计算左心室质量指数.结果 36例患者中有24例颈动脉斑块阳性,阳性率为67%.颈动脉斑块阳性组患者年龄、透析时间和C反应蛋白明显高于斑块阴性组(P<0.05),血浆白蛋白明显低于斑块阴性组(P<0.05).斑块阳性组颈动脉内膜中膜厚度以及反映左心室肥厚的指标如舒张期末室间隔厚度、左心室质量指数显著高于斑块阴性组.结论 维持性血液透析患者颈动脉硬化与左心室肥厚关系密切,动脉硬化的治疗有可能预防和逆转维持性血液透析患者的左心室肥厚.     

Renal resistive index and cardiovascular organ damage in a large population of hypertensive patients

We evaluated the relationship between renal resistive index (RRI) of the intrarenal vasculature and cardiovascular (CV) organ damage such as left ventricular hypertrophy (LVH), diastolic dysfunction and carotid atherosclerosis in a large sample of hypertensive patients. 566 hypertensive patients underwent echocardiography with conventional Doppler and Doppler tissue imaging (DTI), carotid and renal ultrasonography. In addition, lipids profile, creatinine in serum, and urinary albumin concentrations were determined. The patients were divided according to their RRI values in 2 groups: <70 and >or=70. Subjects with high RRI were older, had higher systolic and pulse pressure (PP) and more years of hypertension, compared to those with low RRI (P<0.0001). Patients with the higher RRI showed an increased left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) with a higher prevalence of LVH, carotid plaques and microalbuminuria (P<0.001). There were differences in overall diastolic parameters, in particular when evaluated by DTI (P<0.001). A positive correlation was found between RRI and age, PP, carotid IMT, LVMI, SBP and a negative correlation was found with DTI diastolic parameters (P<0.001). Age, PP, carotid IMT and LVMI were independently related to RRI. While, RRI was independently related to IMT and IVRT. RRI, especially the higher values, are positively correlated with target organ damage in hypertensive patients, indicating that renal vascular resistance is related to morphologic and hemodynamic alteration of the CV system. The evaluation of RRI could predict the presence of early CV damage and provide an accurate estimate of overall risk.     

Correlation between ankle brachial index,carotid intima media thickness and left ventricular hypertrophy in patients on maintenance hemodialysis

IntroductionLeft ventricular hypertrophy (LVH) is a major cardiovascular risk factor in patients on maintenance hemodialysis (HD). The aim of our study is to find correlation between ankle brachial index (ABI), carotid intima media thickness (IMT) and left ventricular hypertrophy in this population.Patient and methodsTwenty consecutive patients on maintenance hemodialysis were studied, all clinical data were included and laboratory data recorded, three most recent pre-dialysis blood pressure measurements were recorded and averaged. Ankle brachial index, also carotid intima media thickness were measured for all patients echocardiography to asses left ventricular wall thickness mainly was done.ResultsThere was positive correlation between IMT and LVH as well as a negative correlation between ABI and LVH in those patients on hemodialysis.Both parameters were correlated with BMI and serum albumin. When serum albumin level rise, ABI increase and IMT decrease indicating no atherosclerotic changes. Left ventricular mass index (LVMI) was also highly negatively correlated with serum albumin. Obesity was found to be associated with more atherosclerotic changes with rise of IMT and lowering of ABI in our work, but not correlated with LVMI. Systolic blood pressure (SBP) was also correlated with more atherosclerotic changes with higher IMT and lower ABI and positively correlated with LVH.ConclusionBoth ABI and carotid IMT are equally effective to predict cardiovascular risk as regard to LVH in hemodialysis population and ABI should be included as a bed side cheap and reliable way to assess cardiovascular risk in hemodialysis patients.     

Associations of serum salusin-alpha levels with atherosclerosis and left ventricular diastolic dysfunction in essential hypertension

Serum salusin-alpha, is decreased in essential hypertension and acute coronary syndrome. The study is aimed to explore whether serum salusin-alpha is associated with atherosclerosis and left ventricular (LV) diastolic dysfunction in essential hypertension. Echocardiography, carotid ultrasonography, brachial-ankle pulse wave velocity (BaPWV) and serum salusin-alpha levels were determined in 60 hypertensive patients (29 with and 31 without carotid plaque) and 30 normotensive controls. Hypertensive patients with plaque, compared with those without plaque or the controls, had the lowest values of salusin-alpha. Then the hypertensive patients were divided into left ventricular hypertrophy (LVH) and non-LVH groups according to the echocardiography. Similarly, hypertensive patients with LVH showed the lowest serum salusin-alpha levels. In all subjects, serum salusin-alpha levels were negatively correlated with carotid mean-intima-media thickness (IMT), BaPWV, left ventricle mass index (LVMI) and E/E' (r=-0.488, P<0.001; r=-0.381, P<0.001; r=-0.294, P=0.006; r=-0.303, P=0.005; respectively). Serum salusin-alpha levels were independent predictors of BaPWV, carotid strain, carotid distensibility, mean-IMT, LVMI and E'/A' (β=-0.399, 0.283, 0.237, -0.346, -0.306, 0.469; P=0.002, 0.031, 0.016, 0.005, 0.012 and 0.001, respectively) in multiple linear regression models. These results suggest that serum salusin-alpha may be associated with atherosclerosis and LV diastolic dysfunction in essential hypertension.     

Low wall shear stress in carotid arteries in subjects with left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular complications including atherosclerosis. The close linkage between LVH and carotid atherosclerosis has been the focus of much research. However, the underlying mechanism linking the two conditions is not fully understood. Low wall shear stress contributes to intimal thickening and atherosclerosis development as a local mechanism. In the present study, we investigated the relationship between wall shear stress and LVH in subjects with risk factors for atherosclerosis. Eighty subjects with at least one risk factor for atherosclerosis; ie, hypertension, diabetes mellitus, hyperlipidemia, or smoking, were enrolled. Intimal-medial thickness (IMT), number of plaques, internal dimensions, and blood flow velocity in the common carotid artery were evaluated. Wall shear stress was calculated using a Poiseuillean parabolic model of velocity distribution: shear stress = 4 x blood viscosity x central flow velocity/internal dimension. Subjects were divided into two groups; LVH(-) (n = 36) and LVH(+) (n = 44), according to their left ventricular mass index (LVMI). Mean shear stress and systolic peak shear stress were significantly lower in subjects with LVH compared with subjects without LVH. Furthermore, mean shear stress (r = -0.42, P < .0001) and peak shear stress (r = -0.31, P < 0.01) were significantly inversely related to LVMI. Stepwise regression analysis revealed that wall shear stress independently correlated with LVMI as well as IMT. These results indicate that low shear stress could function as a local factor in the development of atherosclerosis in subjects with LVH.     

Early carotid atherosclerosis and cardiac diastolic abnormalities in hypertensive subjects

Despite the fact that it is known that hypertension may be associated to early atherosclerosis manifestations, few data are to date available on the relationship between early carotid abnormalities and left ventricular diastolic dysfunction. To address this issue, 142 hypertensive patients (64 females and 78 males) younger than 55 years, at the first diagnosis of mild-to-moderate essential hypertension (WHO/ISH criteria), were selected from a database consisting of 3541 subjects referred to ultrasound cardiovascular laboratory in the last 5 years. Carotid intima-media thickness (IMT) was detected by high-resolution vascular ultrasound and left ventricular structure and function by the use of Doppler echocardiography. According to carotid IMT values, all patients were subgrouped into two groups consisting of 89 (62.6%) pts with IMT > or = 1 mm (A) and 53 (37.4%) pts with IMT < 1 mm (B). Our results show that isovolumic relaxation time (IVRT), deceleration time of E velocity (EDT) and left ventricular relative wall thickness (LV-RWT) were significantly (P < 0.05) higher in group A (IVRT 112 +/- 8.9 ms; EDT 288 +/- 21.8 ms; LV-RWT 0.40 +/- 0.08) than in group B (IVRT 92.3 +/- 4.6 ms; EDT 203.3 +/- 27.01 ms; LV- RWT 0.37 +/- 0.06). Moreover, the prevalence of left ventricular hypertrophy (LVH) was significantly (P < 0.01) higher in group A (30/89; 33.7%) than in group B (8/53; 15%). A positive correlation (P < 0.001) between IMT, EDT and IVRT was found only in hypertensives without LVH. These results are consistent with the indication that IMT evaluation has to be recommended both in hypertensive patients with LVH and in those without LVH, but with left ventricular diastolic dysfunction. This approach might improve the prognostic stratification of hypertensive subjects and it might be suitable to recognize the subset of patients at a higher risk of cardiovascular disease or events early.     

动态脉压对老年高血压患者靶器官损害的影响

目的探讨动态脉压对老年高血压患者靶器官损害的影响。方法选择原发性高血压患者146例,按24 h平均脉压(MPP)分为2组:24 h MPP≥60 mm Hg(1 mm Hg=0.133 kPa)为A组(60例),24 h MPP<60 mm Hg为B组(86例);另选健康体检者为对照组(C组,30例)。所有患者均行血清肌酐、动态血压、超声心动图、颈动脉超声检查;计算肌酐清除率(Ccr)、24 h平均收缩压(MSBP)、24 h平均舒张压、24 h MPP、左心室重量指数(LVMI)、LVEF、颈动脉内膜中层厚度(IMT)。结果与C组比较,A组和B组患者24 h MSBP、24 h MPP、LVMI、IMT、左心室肥厚、左心室功能受损、脑损害、肾功能受损、颈动脉斑块发生率明显升高,Ccr、LVEF水平明显降低(P<0.05,P<0.01);与B组比较,A组患者Ccr、LVEF水平明显降低,24 h MSBP、24 h MPP、LVMI、IMT、靶器官损害发生率均明显升高(P<0.05,P<0.01)。24 h MPP与心脑肾和颈动脉损害相关(P<0.05)。结论动态脉压增大与老年高血压患者靶器官结构和功能的损害相关;动态脉压越大,靶器官损害越严重。     

Maximum value of home blood pressure: a novel indicator of target organ damage in hypertension

The maximum office systolic blood pressure (SBP) has been shown to be a strong predictor of cardiovascular events, independently of the mean SBP level. However, the clinical implications of maximum home SBP have never been reported. We investigated the association between the maximum home SBP and target organ damage (TOD). We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) using ultrasonography and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home BP was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. The maximum home SBP was defined as the maximum mean triplicate BP reading in the 14-day period for each individual and was significantly correlated with LVMI (r=0.51, P<0.001), carotid IMT (r=0.40, P<0.001), and UACR (r=0.29, P<0.001). The correlation coefficients with LVMI and carotid IMT were significantly larger for the maximum home SBP than the mean home SBP. In multivariate regression analyses, the maximum home SBP was independently associated with LVMI and carotid IMT, regardless of the mean home BP level. In the prediction of left ventricular hypertrophy and carotid atherosclerosis, the goodness-of-fit of the model was significantly improved when the maximum home SBP was added to the sum of the mean office and home BPs (P=0.002 and P<0.001, respectively). These findings indicate that assessment of the maximum home SBP, in addition to the mean home SBP, might increase the predictive value of hypertensive TOD in the heart and artery.     

Presence and severity of carotid atherosclerosis in asymptomatic hypertension patients with left ventricular hypertrophy]

BACKGROUND AND PURPOSE: Arterial hypertension is associated with structural changes in the cardiovascular system. In hypertensives, a relationship has been found between left ventricular hypertrophy and carotid wall thickness, whereas the association with atherosclerotic plaque is less defined. The aim of this study was to evaluate the occurrence and severity of carotid atherosclerosis in hypertensive patients with or without left ventricular hypertrophy (LVH). MATERIALS AND METHODS: We studied 122 hypertensive subjects (62 men and 60 women), aged 60.1 +/- 12.1. Subjects were considered to have left ventricular hypertrophy if their left ventricular mass index (LVMI) at echocardiography exceeded 110 g/m2 in women and 135 g/m2 in men. Carotid intima-media thickness (IMT), external diameter and atherosclerotic plaques were evaluated by high resolution echo-color Doppler. RESULTS: IMT in both common carotid and bifurcation was significantly greater in hypertensives with LVH (p < 0.01), whereas external diameter did not differ significantly in the two groups. Increased presence (73.4 vs 32.8%) and severity (18.7 vs 5.2% for stenosis > 40%) of atherosclerotic plaque were found in the hypertrophic group. A weak but significant association was present among left ventricular mass index, ventricular wall thicknesses and carotid intima-media thickness, and plaque. CONCLUSIONS: In asymptomatic hypertensive subjects, LVH is associated with an increased risk of plaque formation and progression. Vascular hypertrophy may represent a distinct prognostic factor in hypertension and the association of cardiac and vascular hypertrophy may identify a group at high risk of future cardiovascular events.