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中华心脏与心律电子杂志 ›› 2023, Vol. 11 ›› Issue (03) : 165 -172. doi: 10.3877/cma.j.issn.2095-6568.2023.03.006

临床研究

静息血压和运动血压与心脏结构和功能的相关性研究
米娜瓦尔·阿不都克力木, 周圆缘, 黄慧玲, 董吁钢, 刘晨, 魏方菲()   
  1. 510080 广州,中山大学附属第一医院心内科 国家卫生健康委员会辅助循环重点实验室(中山大学)
  • 收稿日期:2023-05-12 出版日期:2023-09-25
  • 通信作者: 魏方菲
  • 基金资助:
    国家自然科学基金(82000372)

The associations of cardiac structure and function with blood pressure at rest and during exercise

Abudukelimu Minawaer, Yuanyuan Zhou, Huiling Huang, Yugang Dong, Chen Liu, Fangfei Wei()   

  1. Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-05-12 Published:2023-09-25
  • Corresponding author: Fangfei Wei
引用本文:

米娜瓦尔·阿不都克力木, 周圆缘, 黄慧玲, 董吁钢, 刘晨, 魏方菲. 静息血压和运动血压与心脏结构和功能的相关性研究[J/OL]. 中华心脏与心律电子杂志, 2023, 11(03): 165-172.

Abudukelimu Minawaer, Yuanyuan Zhou, Huiling Huang, Yugang Dong, Chen Liu, Fangfei Wei. The associations of cardiac structure and function with blood pressure at rest and during exercise[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 165-172.

目的

比较静息和运动时收缩压和舒张压与心脏结构和功能的相关性。

方法

回顾性纳入2019年1月至2020年10月在中山大学附属第一医院7 d内完善运动心电-动态心排(二合一)及超声心动图检查的门诊患者,收集患者年龄、性别、心血管共病、静息和运动血压以及超声心动图的左心房内径(LAD)、室间隔厚度(IVST)、左心室舒张末后壁厚度(LVPWT)等结构指标、左心室舒张早期最大血流速度(E峰)、左心室舒张晚期最大血流速度(A峰)、侧壁侧二尖瓣环和室间隔侧二尖瓣环舒张早期运动速度的平均值(e’)等舒张功能指标及左心室射血分数(LVEF)为代表的收缩功能指标。通过多因素线性回归模型比较静息和运动时收缩压和舒张压与心脏结构和功能的相关性。

结果

共纳入323例受试者,年龄(46.2±15.1)岁,其中男占40.2%(130/323),13.6%(44/323)为冠心病患者。校正性别、年龄、体重指数、有无冠心病及静息血压,运动收缩压/运动舒张压每增加1-标准差(SD),IVST及LVPWT分别增加0.33 mm(P<0.001)/0.33 mm(P<0.001)和0.32 mm(P<0.001)/0.24 mm(P=0.004),而运动收缩压与心脏舒张功能指标之间的相关性无统计学意义。校正性别、年龄、体重指数、有无冠心病及运动血压后,静息收缩压每增加1-SD,A峰及E/e’分别增加3.93 mm/s(P<0.001)和0.46(P=0.002),而静息舒张压每增加1-SD,A峰增加2.91 mm/s(P=0.005),E/A减少0.08(P=0.002);静息收缩压每增加1-SD,IVST增加0.26 mm(P=0.007),但静息收缩压与其他心脏结构指标的相关性无统计学意义。而校正混杂因素后,心脏收缩功能指标LVEF与运动血压及静息血压均不相关。

结论

运动血压独立于静息血压水平主要与心脏结构指标相关,而静息血压独立于运动血压水平主要与心脏舒张功能指标相关。

Objective

To investigate whether exercise blood pressure (BP) was associated with cardiac structure and function independent of BP at rest.

Methods

In the outpatients who underwent non-invasive cardiac exercising test and echocardiography at The First Affiliated Hospital of Sun Yat-Sen University between January 2019 and October 2020, collected the clinical data and retrospectively assessed the association of cardiac structure (i.e., left atrial internal diameter, interventricular septal wall thickness, left ventricular posterior wall thickness), diastolic function [i.e., the peak early-diastolic (E) and peak end-diastolic (A) transmission velocity, the mean early-diastolic myocardial velocity (e')], and systolic function (left ventricular ejection fraction) with 1-SD increment in BP during exercise and at rest, using multivariable regression analyses.

Results

Among the 323 participants, age averaged (46.2±15.1) years. 40.2% (130/323) were men, and 13.6% (44/132) had coronary heart disease. With adjustments applied for gender, age, body mass index, coronary heart disease, and BP at rest, the association sizes with 1-SD increase in exercise systolic, and diastolic BP were 0.33 mm (P<0.001) / 0.33 mm (P<0.001) for interventricular septal wall thickness, and 0.32 mm (P<0.001) / 0.24 mm (P=0.004) for left ventricular posterior wall thickness, while the association sizes were non significant for the associations between indices of cardiac function and exercise systolic BP. After adjusted for gender, age, body mass index, coronary heart disease, and exercise BP, the association sizes with 1-SD increase in systolic BP at rest were 3.93 mm/s (P<0.001) for A peak and 0.46 (P=0.002) for E/e'. The association sizes with 1-SD increase in diastolic BP at rest were 2.91 mm/s (P=0.005) for A peak and -0.08 (P=0.002) for E/A, and 1-SD increase in systonic BP at rest were 0.26 mm for IVST (P=0.007), while there were no associations between indices of cardiac structure and systolic BP at rest with exception for interventricular septal wall thickness. After accounted for potential confounders, there was no association of left ventricular ejection fraction with BP during exercise and at rest.

Conclusion

Exercise BP was mainly associated with cardiac structure independent of BP at rest, while BP at rest was mainly correlated with cardiac diastolic function independently of exercise BP.

表1 323例受试者基线特征及心脏结构和功能指标
表2 在323例门诊患者收缩压与心脏结构和功能指标的相关性
图1 E/e’与血压相关性(1A为E/e’与静息收缩压;1B为E/e’与运动收缩压;1C为E/e’与静息舒张压;1D为E/e’与运动舒张压)E为二尖瓣舒张早期血流,e’为侧壁侧二尖瓣环和室间隔侧二尖瓣环舒张早期运动速度的平均值,E/e’为E峰与e’的比值
表3 323例门诊患者舒张压与心脏结构和功能指标的相关性
表4 323例门诊患者静息血压和运动血压与心脏结构和功能指标的相关性
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