masked hypertension and left atrial dysfunction a hidden association marijana tadic资料.pdf

该【masked hypertension and left atrial dysfunction a hidden association marijana tadic资料 】是由【四婆子】上传分享，文档一共【7】页，该文档可以免费在线阅读，需要了解更多关于【masked hypertension and left atrial dysfunction a hidden association marijana tadic资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。ORIGINALPAPERMaskedHypertensionandLeftAtrialDysfunction:AHiddenAssociationMarijanaTadic,MD,PhD;1,2CesareCuspidi,MD;3JanaRadojkovic,MD;1BranislavRihor,MD;1VesnaKocijanic,RN;1VeraCelic,MD,PhD1,2FromtheUniversityClinicalHospitalCenter“-Dedinje”,CardiologyDepartment,Belgrade,Serbia;1FacultyofMedicine,Belgrade,Serbia;2andUniversityofMilan-aandIstitutoAuxologicoItaliano,ClinicalResearchUnit,Meda,Italy3Maskedhypertension(MH)isaclinicalconditionthatfunctiongraduallydecreased,whileLAboosterpumpindicatesnormalvaluesofclinicbloodpressure(BP)butfunctionprogressivelyincreased,fromnormotensiontoelevated24-(LA)two--haracter--sectionalstudyistics,24-hoursystolicBPwasassociatedwithLApassiveincluded49normotensiveindividuals,50patientswithMH,ejectionfraction,LAtotallongitudinalstrain,LApositiveand70untreatedsustainedhypertensivepatientsadjustedlongitudinalstrain,,-,and24-hoursystolicBPincrementwascloselylowerinpatientswithMHandthosewithsustainedhyper-(Greenwich).;00:1–,,theincreasingdetailsregardingLAvolume(LAV)andphasicfunction,useofambulatorybloodpressure(BP)monitoringandtheydidnot?ndasigni?cantdifferencebetween(ABPM)hasrevealedthewholerangeofdifferentBPnormotensivecontrol,sustainedhypertensive,andMHpatternssuchaswhite-coathypertension,,LAremodelingcouldsigni?-hypertension,nocturnalhypertension,andnormoten--,recent?,aswellasLVdysfunctionandLVcouldprovidetrueandprognosticinformationonBPimpairedmechanics,wasassociatedwithadverseout-,itappearedthatshowsimportantprognosticvalueofBPvariability,prehensiveassessmentofLAphasicfunctionassessedby24-hourABPM,inwhite-??rsttousethetermWehypothesizedthatMHaffectsLAfunctionandmaskedhypertension(MH).3Shortlythereafterinvesti-?uenceinvestigateLAphasicfunctioninpatientswithMHandamage,includingcardiacandsustainedhypertensionvsthosewithnormotensionhypertrophy,carotidatherosclerosis,andalbumin-usingvolumetricandspeckletrackinganalysis.–-,8Thisinvestigationincluded169untreatedpatientsOurrecentmeta--riskofleftventricular(LV)structuralchanges,-,symptomsorsignsofheartfailure,coronaryLeftatrial(LA)remodelinghasnotbeensuf?cientlyarterydisease,previouscerebrovascularevents,?brillation,congenitalheartdisease,heartvalvediseaseprovideddataonlyonLAdiameter,withoutanyfurther(morethanmild),neoplasticdisease,livercirrhosis,kidneyfailure,andendocrinediseases(includingtype2diabetesmellitus).Addressforcorrespondence:MarijanaTadic,MD,PhD,UniversityAnthropometricmeasures(height,weight)andlabo-ClinicalHospitalCenter“-Dedinje”,HerojaMilanaratoryanalyses(leveloffastingglucose,bloodcrea-Tepica1,11000Belgrade,Serbiatinine,totalcholesterol,andtriglycerides)wereobtainedE-mail:marijana_******@:June26,2016;revised:July21,2016;accepted:July23,2016index(BMI)andbodysurfacearea(BSA)werecalcu-DOI:.TheJournalofClinicalHypertension1MaskedHypertensionandLeftAtrium|-diastole(e0).Theaverageofthepeakearlydiastolictee,andinformedconsentwasobtainedfromallrelaxationvelocity(e0),andtheE/-HourABPMAllparticipantsunderwent24-:maximalLAVwasmeasuredjustbeforemeasurementsinthesittingposition,takenwithinanthemitralvalveopening,pre-A(preatrialcontraction)intervalof5to10minutes,afterthepatienthadrestedLAVwasdeterminedattheonsetofatrialsystole(),andminimalLAVwasmeasuredatThenoninvasive24-,usingaSchillerBR-ordingtothebiplanemethodinfour-andtwo-systemBPmonitor(SchillerAG,Baar,Switzerland).chamberviews,–parameterofLAreservoir20-minuteintervalsduringtheday(7AM–11PM)andatfunctionwascalculatedasthedifferencebetween30-minuteintervalsduringthenight(11PM–7AM).maximumandminimumLAV,passiveemptyingvol-NighttimeBPwasde?nedastheaverageofBPsfromtheume–conduitfunctionparameterwascalculatedasthetimepatientswenttobeduntilthetimetheygotoutofdifferencebetweenmaximumandpre-ALAV,andbed,anddaytimeBPwasde?nedastheaverageofBPsactiveemptyingvolume–LAboosterfunctionparam--Aandthenanalyzedtoobtain24-,totalemptyingfraction(SBP)anddiastolicBP(DBP).Whenthereadings(EF)wascalculatedastheratiobetweentotalemptyingexceededatleast70%ofthetotalreadingsprogrammedvolumeandmaximumLAV,putedforthetestingperiod,therecordingwasconsideredastheratiobetweenpassiveandmaximum,?nedasanormalclinicBP(SBPpre-ALAV.<140mmHgandDBP<90mmHg)measuredonat2DEstrainimagingwasperformedintheapicalfour-asionsassociatedwitha24-hourandtwo-merciallyavailableambulatorySBP>130mmHgand/orDBP>80mmsoftwareEchoPAC201(GEHealthcare,Horten,,patientswithsustainedNorway)-hourambulatorySBP≥≥-dinalstraincurvewasautomaticallygenerated,anditEchocardiographyincludedanegativede?ection(LAnegativelongitudinalEchocardiographicexaminationswereperformedusingstrain),representingLAactivecontraction,followedbyacommerciallyavailableVivid7device(GEVingmed,apositiveoneduringLA?lling(LApositivelongitudinalHorten,Norway).Reportedvaluesofalltwo-dimen-strain).TheirsummationrepresentedtotalLAlongitu-sionalechocardiographic(2DE)(positive,negative,andtotal)wasobtainedastheaveragevalueofthreeconsecutivecalculatedbyaveragingthevaluesobtainedinfour--’(e’istheaveragebetweenseptalandlateralordingtotheformula:(29posteriore’values))/LVend---StatisticalAnalysistionfraction(EF)wascalculatedbyusingthebiplaneContinuousvariableswerepresentedasmean?stan-(LVM)paredbyanalysisofcorrectedmethoddescribedinthejoinedguidelinesofvariance,-theAmericanandEuropeansocietiesofechocardiogra--(clinicLVmyocardialvelocitiesintheapicalfour-chamberand24-hour)independentlyofage,BMI,LVMindexview,withasamplevolumeplacedattheseptaland(LVMI),andE/e’.APvalue<.05wasconsideredlateralsegmentsofthemitralannulusduringearlystatisticallysigni?|,AllthreegroupswereofsimilarageandsexdistributionthroughoutMH,tosustainedhypertensivepatients(TableI).TherewasnodifferenceinBMI,although(TableIIIandFigure).ActiveLAVandactiveLAEFBSAwassomewhathigherintheMHandsustainedgraduallyincreasedfromnormotensivestosustainedhypertensivegroupsthanincontrols(TableI).Hearthypertensivepatients(TableIIIandFigure).,anddecreasedfromcontrolstosustainedhypertensivesigni?cantlyhigherinthesustainedhypertensivegrouppatients,whereasnegativeLAlongitudinalstrainwas(TableI).Ontheotherhand,24-hourBPwassigni?-higherinMHandsustainedhypertensivesthanincantlyhigherintheMHandsustainedhypertensivenormotensivecontrols(TableIIIandFigure).groupsthanincontrols(TableI).PlasmaglucoseandLAstiffnessindexsigni?cantlyandprogressivelycreatininelevelsweresimilarthroughoutthegroups,increasedfromnormotensivecontrols,acrossMH,towhereascholesterolandtriglyceridelevelswerehighersustainedhypertensivepatients(TableIII).,whileLV(b=à,P=.012),LAtotallongitudinalstraininterventricular,posteriorwall,andrelativewallthick-(b=à,P<.001),andLAstiffnessindex(b=,nessesweresigni?cantlyhigherintheMHandsustainedP<.001)independentlyofage,BMI,LVstructure,andhypertensivepatientsthanincontrols(TableII).-four-hourSBPwasassociatedwithLApas-patientstohypertensivepatients(TableII).TherewassiveEF(b=à,P<.001),(b=à,P<.001),LApositivelongitudinalMitralE/AratiodecreasedandmitralE/e’ratiostrain(b=à,P<.001)andLAstiffnessindexincreasedgraduallyfromnormotensivetosustained(b=,P<.001)independentlyofmainclinicalandhypertensive(TableII).(maximum,minimum,andpre-A)andcorre-DISCUSSIONspondingLAVindexesprogressivelyandsigni?cantlyOurstudyrevealedseveralnew?,maxi-increasedfromnormotensivecontrolstosustainedmum,minimum,andpre-ALAVsweresigni?cantlyhypertensivepatients(TableIII).higherinMHpatientsthanincontrols,butstilllowerTherewasnosigni?,,whichdescribesLAandreservoirLAfunctionwerereducedinMHpatientsreservoirfunction,paredwithcontrols,whereasLApumpfunctionhypertensivepatientsthaninnormotensivecontrolsincreasedfromcontrolstosustainedhypertensive(TableIIIandFigure).,LAstiffnessindexprogressivelyhypertensivepatientsthanincontrolsandMHpatients,increasedfromnormotensives,throughoutMH,toandpassiveLAEF,aparameterofLAconduitfunction,,24-(n=49)MH(n=50)HTN(n=70)PValueAge,y56?759?758?,%23(47)22(44)32(46).957BMI,kg/???,???,beatspermin71?671?772?