老年高血压患者左心室构型与运动耐量的相关性

Correlation between left ventricular configuration and exercise tolerance in elderly patients with hypertension

摘要

摘要：目的 探讨老年高血压患者左心室构型与运动耐量的相关性及性别差异。方法 纳入 835 例年龄≥60岁的原发性高血压患者作为病例组，按 Ganau 分型分为正常构型（NL）、向心性重构（CR）、离心性肥厚（EH）、向心性肥厚（CH）四个亚组；同时收集 151 例同时期年龄≥60 岁的非高血压且正常心脏构型的人群作为对照组。比较 5 组峰值摄氧量（Peak VO₂）差异；采用多元线性回归分析探讨左心室结构参数——左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、舒张末期室间隔厚度（IVST）、左心室后壁厚度（PWT）、相对室壁厚度（RWT）和左心室质量指数（LVMI）与 Peak VO₂ 的相关性及男女差异。结果 高血压四个构型亚组（NL、CR、EH、CH）的 Peak VO₂ 较对照组低[（16.20±4.93）、（15.56±5.18）、（13.56±4.92）、（13.27±4.40）比（18.14±4.76）mL/（kg·min），P＜0.001]；高血压患者中，异常构型组的 Peak VO₂ 较 NL 组低（P ＜ 0.001）。男性的 NL 及CR 构型比例高于女性，EH 及 CH 构型比例低于女性。多元线性回归分析结果显示，在老年高血压患者中，调整年龄、性别、吸烟史、饮酒史、收缩压、舒张压、体重指数、高血压病程、心率、空腹血糖、总胆固醇、甘油三酯、血清尿酸、降压药物使用等因素后，IVST 与 Peak VO₂ 独立负相关（B = −0.264，P=0.028）。IVST 在男性患者是Peak VO₂ 的独立负相关因素（B = −0.551，P＜0.001），而在女性患者该相关性无统计学意义（B = −0.033，P =0.323）。结论 老年高血压患者的运动耐量低于非高血压老年人，其中左心室异常构型组的运动耐量低于正常构型组；老年男性患者 IVST 和运动耐量独立负相关。

Abstract

Objective To explore the correlation and gender differences between left ventricular (LV) morphology and exercise tolerance in elderly patients with hypertension. Methods A total of 835 patients aged≥60 with essential hypertension were included as case groups. According to the Ganau classification, they were divided into four subgroups: normal configuration (NL), concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH). At the same time, 151 non-hypertensive and normal heart configuration people aged ≥ 60 years were collected as a control group. The differences were compared in Peak oxygen consumption（Peak VO₂) among the five groups. Multiple linear regression analysis was used to explore the correlation between Peak VO₂ and LV structural parameters, including LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum thickness (IVST), LV posterior wall thickness (PWT), relative ventricular wall thickness (RWT) and LV mass index (LVMI) in total subjects, as well as in men and women. Results The Peak VO₂ in the four configuration subgroups of hypertension (NL, CR, EH, CH) was lower than that in the control group ([16.20 ± 4.93], [15.56 ± 5.18], [13.56 ± 4.92], [13.27 ± 4.40]vs. [18.14 ± 4.76] mL/(kg·min),P＜0.001), and the Peak VO₂ of the three abnormal configuration groups was lower than that of the NL group (P＜0.001). The proportions of NL and CR patterns were higher in males than in females, while the proportions of EH and CH patterns were lower in females. Multiple linear regression analysis showed that in the entire elderly hypertensive population, after adjusting for age, sex, smoking history, drinking history, systolic blood pressure, diastolic blood pressure, body mass index, duration of hypertension, heart rate, fasting blood glucose, total cholesterol, triglycerides, serum uric acid, and use of antihypertensive drugs, IVST was independently negatively correlated with Peak VO₂ (B = −0.264, P = 0.028). IVST was an independent negative predictor of Peak VO₂ in male patients (B = −0.551, P＜0.001), whereas no statistically significant correlation was found in female patients (B = −0.033, P = 0.323). Conclusions The exercise tolerance of elderly hypertensive patients is lower than that of non-hypertensive elderly people; and the exercise tolerance of the left ventricular abnormal configuration groups is lower than that of the normal configuration group; IVST is independently negatively correlated with exercise tolerance in elderly male patients.

关键词

高血压 / 老年 / 左心室构型 / 心肺运动试验 / 运动耐量 / 性别

Key words

hypertension / elderly / left ventricular geometry / cardiopulmonary exercise test / exercise tolerance / gender

参考文献

[1] Han M, Qie R, Shi X, et al. Cardiorespiratory fitness and mortality from all causes, cardiovascular disease and cancer: dose—response meta—analysis of cohort studies[J]. Br J Sports Med, 2022, 56(13): 733-739.

[2] 叶福银 . 老年高血压患者运动血压反应及心肺耐量评估[D]. 南昌: 南昌大学, 2018.

[3] 李莉, 严静, 龚仕金, 等 . 高血压患者左心室结构与运动耐量的相关性研究[J]. 解放军医学杂志, 2011, 36(1): 64-67.

[4] Movahed MR, Ramaraj R, Manrique C, et al. Left ventricular hypertrophy is independently associated with all—cause mortality[J]. Am J Cardiovasc Dis, 2022, 12(1): 38-41.

[5] 沈逸华, 林沁, 谢良地 . 心肺运动试验的指标及结果解读[J]. 中华高血压杂志, 2019, 27(1): 84-88.

[6] Canciello G, Piccolo R, Izzo R, et al. Sex—related differences in left ventricular geometry patterns in patients with arterial hypertension[J]. JACC Adv, 2024, 3(10): 101256.

[7] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中国医疗保健国际交流促进会高血压病学分会, 等 . 中国高血压防治指南 (2024 年修订版)[J]. 中华高血压杂志 (中英文), 2024, 32(7): 603-700.

[8] Cohen J . Statistical power analysis for the behavioral sciences[M]. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.

[9] Dores H, Mendes M, Abreu A, et al. Cardiopulmonary exercise testing in clinical practice: principles, applications, and basic interpretation[J]. Rev Port Cardiol, 2024, 43(9): 525-536.

[10] Sheng Y, Li M, Xu M, et al. Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data[J]. Eur Heart J Cardiovasc Imaging, 2022, 23(2): 166-174.

[11] Niu J, Zeng M, Wang Y, et al. Sensitive marker for evaluation of hypertensive heart disease: extracellular volume and myocardial strain[J]. BMC Cardiovasc Disord, 2020, 20(1): 292.

[12] Tadic M, Ivanovic B . Why is functional capacity decreased in hypertensive patients? From mechanisms to clinical studies[J]. J Cardiovasc Med (Hagerstown), 2014, 15(6): 447-455.

[13] Ferreira C, Trindade F, Ferreira R, et al. Sexual dimorphism in cardiac remodeling: the molecular mechanisms ruled by sex hormones in the heart[J]. J Mol Med (Berl), 2022, 100(2): 245-267.

[14] Yusifov A, Woulfe KC, Bruns DR . Mechanisms and implications of sex differences in cardiac aging[J]. J Cardiovasc Aging, 2022, 2: 20.

[15] Ji H, Kim A, Ebinger JE, et al. Sex differences in blood pressure trajectories over the life course[J]. JAMA Cardiol, 2020, 5(3): 19-26.

[16] Pierson LM, Bacon SL, Sherwood A, et al. Association between exercise capacity and left ventricular geometry in overweight patients with mild systemic hypertension[J]. Am J Cardiol, 2004, 94(10): 1322-1325.

[17] Lam CSP, Grewal J, Borlaug BA, et al. Size, shape, and stamina: the impact of left ventricular geometry on exercise capacity[J]. Hypertension, 2010, 55(5): 1143-1149.

[18] Tsao CW, Gona PN, Salton CJ, et al. Left ventricular structure and risk of cardiovascular events: a Framingham heart study cardiac magnetic resonance study[J]. J Am Heart Assoc, 2015, 4(9): e002188.

[19] Hasan Noaman A, Al—Salihi O. Low exercise capacity is independent of LVMI despite significant change in diastolic function in young non complicated hypertensive patients[J]. Al—Kufa Univ J Biol, 2019, 11(1): 24-29.

[20] Iso Y, Kitai H, Kubota M, et al. Is systolic blood pressure an early marker of concentric left ventricular geometry in young rugby athletes as a potential cardiac maladaptation?[J]. Int J Cardiol Cardiovasc Risk Prev, 2025, 24: 200362.

[21] Jin H, Wang X, Dai H, et al. Association of leisure—time physical activity and mortality risk in high cardiovascular risk population with and without left ventricular hypertrophy[J]. Rev Cardiovasc Med, 2023, 24(10): 285.

[22] Palatini P, Visentin P, Dorigatti F, et al. Regular physical activity prevents development of left ventricular hypertrophy in hypertension[J]. Eur Heart J, 2009, 30(2): 225-232.

[23] Marsh ML, Oliveira MN, Vieira—Potter VJ . Adipocyte metabolism and health after the menopause: the role of exercise[J]. Nutrients, 2023, 15(2): 444.

[24] Bielecka—Dabrowa A, Gryglewska K, Sakowicz A, et al. Obesity and body mass components influence exercise tolerance and the course of hypertension in perimenopausal women[J]. J Cardiovasc Dev Dis, 2022, 9(8): 238.

基金资助

福建省卫生健康科技计划项目(2022CXB014)