Left ventricular diastolic functions in non-hypertensive subjects with inappropriate left ventricular mass.

초록

Background: Inappropriately high left ventricular mass(iLVM) has known to be a prognostic indicator for cardiovascular mortality. But regarding the viewpoint of left ventricular functions, few data is available for the nonhypertensive subjects with iLVM. We investigated the influences of iLVM on the diastolic function parameters in non-hypertensive subjects. Methods: From the echocardiography database of Hanyang University Hospital, the ratio observed left ventricular mass(LVM)/predicted LVM was calculated. Predicted LVM was determined by the equation of 55.37 + 6.64xheight(m2.7) + 0.64xstroke work - 18.07 x gender(male=1, female=2). LV end-diastolic and end-systolic volumes were calculated using Teichholz`s formula. Stroke volume was generated (mL/beat) and stroke work (SW in gram-meters/beat [g-m/beat]) was computed as cuff systolic BP x stroke volume x 0.0144. iLVM is definded as observed/predicted LVM > 1.31. Parameters for diastolic function were transmitral E, A, EtoA, DT, IVRT, LA dimension. Results: Compared to appropriate LVM group(N=136), iLVM group(N=92) is older(43.6 14.6 vs 51.3 13.2 p=0.001), higher in BMI(21.8 2.8 vs 24.6 3.16, p=0.001), lower in systolic blood pressure(117.5 9.5 vs 114.5 9.8 mmHg, p=0.01), higher in triglyceride level(119.6 63.7 vs 141.1 78.5, p=0.05), and higher in metabolic syndrome prevalence(13.9% vs 43.4%, p=0.001). iLVM group was low in E to A ratio(1.43 0.03 vs 1.21 0.03, p=0.001) and in stroke volume per body surface area(44.2 7.3 vs 41.9 6.4, p=0.01) and LA dimension was higher(2.75 0.38 vs 2.87 0.38, p=0.001). Observed/preserved LVM was independent of age and systolic blood pressure regarding the influence on the LA dimension and E to A ratio. Conclusions: Inappropriateness of LVM is a significant factor for left ventricular dysfunction even in non-hypertensive patients and the metabolic disturbance is one of the contributor for iLVM.