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左心室の血液動力学的負荷と収縮性能と,高血圧における左心室質量との関係
A Ganau1, R B Devereux, T G Pickering
1Cardiovascular and Hypertension Center, New York Hospital-Cornell Medical Center, NY 10021.
Circulation
|January 1, 1990
まとめ
高血圧の左心室質量は,血圧だけでなく,腔のサイズと収縮性によって影響を受けます. この研究は,高縮が血液動力学的負荷と一致することを示し,室容積が重要な要因である.
科学分野:
- 心臓病学 心臓病学
- 生理学 生理学とは
- バイオメディカルエンジニアリング
背景:
- 静脈血圧と左心室質量との弱い相関は,高血圧における心筋成長に影響を与える非血動学的要因を示唆しています.
- 左心室腔の大きさ,血動力学的負荷,および心筋収縮性の役割を理解することは,多動性の発達を説明するために重要である.
研究 の 目的:
- 血液動力学的な体積負荷と収縮性を反映した左心室腔の大きさが,高血圧における左心室縮に影響する仮説を検証する.
- 高血圧患者の左心室質量と腔体積,圧力,負荷,収縮性との関係を調査する.
主な方法:
- Mモードと二次元エコーカルディオグラムを50人の正常な被験者と50人の未治療のエッセンシャル高血圧患者で利用しました.
- 総負荷とピーク・メリディオナル・フォース・インデックスを用いて左心室負荷を評価.
- 静脈血圧と終盤静脈直径に基づいて理論的に最適な左心室質量を計算した.
主要な成果:
- 左心室の質量は,静脈血圧 (r=0.45) よりも,終末ダイアストリック容量 (r=0.56) と総負荷/ピークメリディオン力 (r=0.68-0.70) とよりよく相関していた.
- 多変量分析により,左心室質量 (R=0.75) の独立した予測因子として,終末ダイアストリック体積と血圧が明らかになった.
- 実際の左心室質量と理論的に最適の左心室質量は密接に関連していた (r=0.76),これは高縮が血動力学的負荷に並行することを示している.
結論:
- 高血圧における左心房縮は,血圧のみではなく,腔のサイズと血液動力学的負荷によって大きく影響されます.
- 腔体積,脳卒中指数,収縮性は,左心室質量の主要な決定因子であり,その変動性のかなりの部分を集約的に説明します.
- この発見は,弱い血圧-質量関係が単に非血動力学的であるとの解釈に異議を唱え,室の寸法の大切さを強調しています.
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