高血压患者V1导联p波终末力异常与左室舒张功能不全的关系:LIFE研究

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Blood Pressure Pub Date : 2017-04-01 Epub Date: 2016-08-09 DOI:10.1080/08037051.2016.1215765

Michael T Tanoue, Sverre E Kjeldsen, Richard B Devereux, Peter M Okin

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引用次数: 17

摘要

背景:V1导联p波末端力异常(PTF-V1)是左房容积增加、左房充盈压力升高和/或左房收缩功能障碍的心电图标志。由于左室(LV)舒张功能障碍是驱动LA重构的潜在机制之一，我们假设PTF-V1可能是舒张功能障碍的另一个ECG标志物。方法:对431例接受方案驱动降压的高血压患者进行系统降压治疗3年后的左室舒张功能与基线PTF-V1的关系进行检查，这些患者有基线和3年的心电图和超声心动图数据，3年时左室射血分数(EF >45%)保持不变。舒张功能异常由405名无明显心血管疾病、血压正常、非肥胖和非糖尿病的成年人的第10或第90百分位值来定义。167例(38.7%)患者PTF-V1异常，表现为V1导联终末p波负向≥4000 μV·ms。结果:异常PTF-V1与糟糕的三年级平均舒张压前三分之一灌装时间(0.43±0.08 vs 0.40±0.07秒,p = 0.039),上半年灌装时间(0.55±0.07 vs 0.53±0.07秒,p = 0.041),二尖瓣速度(86±27 vs 76±19厘米/秒,p = 0.009)和二尖瓣E / A比值(0.85±0.22 vs 0.94±0.27,p = 0.007)调整后舒张功能不全的其他潜在的预测因子包括种族,和心率,收缩压和心电图LVH严重程度的基线康奈尔产品标准。在平行多因素logistic回归分析中，PTF-V1异常与二尖瓣E/A比异常的几率显著增加相关(OR 1.55, 95%CI 1.04-2.32 p = 0.032)，并且在随访第3年时，二尖瓣半充盈时间异常的几率有升高的趋势(OR 1.42, 95%CI 0.94-2.15, p = 0.098)。结论:V1导联p波末端力异常与舒张功能恶化有关，并可预测保留EF患者在降压治疗3年后的左室舒张行为异常。

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Relationship between abnormal P-wave terminal force in lead V₁ and left ventricular diastolic dysfunction in hypertensive patients: the LIFE study.

Background: Abnormal P-wave terminal force in lead V₁ (PTF-V₁) is an ECG marker of increased left atrial (LA) volume, elevated LA filling pressures and/or LA systolic dysfunction. Because left ventricular (LV) diastolic dysfunction is one of the potential mechanisms driving LA remodelling, we hypothesized that PTF-V₁ might be an additional ECG marker of diastolic dysfunction.

Methods: LV diastolic function after 3 years' systematic antihypertensive treatment was examined in relation to baseline PTF-V₁ in 431 hypertensive patients undergoing protocol-driven blood pressure reduction who had baseline and year-3 ECG and echocardiographic data and a preserved LV ejection fraction (EF >45%) at year-3. Abnormal diastolic function was defined by the tenth or 90th percentile values from 405 normotensive, non-obese and non-diabetic adults without overt cardiovascular disease. Abnormal PTF-V_1, defined by the presence of a negative terminal P-wave in lead V1 ≥ 4000 μV·ms, was present in 167 patients (38.7%).

Results: Abnormal PTF-V₁ was associated with worse year-3 mean diastolic first third filling time (0.43 ± 0.08 vs 0.40 ± 0.07 sec, p = 0.039), first half filling time (0.55 ± 0.07 vs 0.53 ± 0.07 sec, p = 0.041), mitral valve A velocity (86 ± 27 vs 76 ± 19 cm/sec, p = 0.009) and mitral valve E/A ratio (0.85 ± 0.22 vs 0.94 ± 0.27, p = 0.007) after adjusting for other potential predictors of diastolic dysfunction including race, and heart rate, systolic blood pressure and severity of ECG LVH by Cornell product criteria at baseline. In parallel multivariate logistic regression analysis, abnormal PTF-V₁ was associated with significantly increased odds of abnormal mitral valve E/A ratio (OR 1.55, 95%CI 1.04-2.32 p = 0.032), and a trend toward higher odds of abnormal half filling time (OR 1.42, 95%CI 0.94-2.15, p = 0.098) at year-3 of follow-up.

Conclusions: Abnormal P-wave terminal force in lead V₁ is associated with worse diastolic function and predicts abnormal LV diastolic behaviour in patients with preserved EF after 3 years of blood pressure reductive therapy.

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来源期刊

Blood Pressure 医学-外周血管病

CiteScore

3.00

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.