左心室肥厚与脑血流动力学变化及脑卒中发病风险的关系
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摘要
目的探讨心电图定义的左心室肥厚(LVH)与脑血流动力学指数(CVHI)变化及脑卒中发病风险的关系。方法从上海市奉贤区某镇脑血管病危险因素队列研究人群中,选择年龄≥65岁的调查者1720例,并分为LVH组101例和对照组1619例,对2组基线调查过程中收集的危险因素、LVH、CVHI等信息及其与脑卒中发病风险的关系进行分析。结果 LVH组和对照组CVHI分别为(56.83±32.01)分和(72.17±29.52)分,CVHI<75分的比例分别为66.3%和42.4%,改良Framingham卒中风险(FSP)评分分别为(17.22±4.12)分和(11.03±3.65)分,2组比较均有统计学差异(P<0.01)。LVH组除左侧最大流速外,右侧最大流速、双侧平均血流量、最小流速、平均流速等显著低于对照组(P<0.05),双侧外周阻力、脉搏波速等显著高于对照组(P<0.05)。LVH、CVHI和FSP评分预测脑卒中发病风险的相对危险度分别为1.69(95%CI:0.76~3.73)、3.17(95%CI:1.81~5.54)和1.35(95%CI:0.67~2.71)。控制年龄、性别及3个预测因素间的相互影响后,仅CVHI为脑卒中的独立预测因素。结论LVH有可能导致CVHI明显异常,CVHI是脑卒中的独立预测因素。
Objective To study the relationship of ECG-defined left ventricular hypertrophy(LVH)with cerebrovascular hemodynamic index(CVHI)and risk facrors for ischemic stroke.Methods A total of 1720 subjects with their age≥65 years from a cerebrovascular disease cohort in Fengxian District of Shanghai City were divided into LVH group(n=101)and control group(n=1619).Relationship of LVH,CVHI and Framingham stroke profile(FSP)score with risk factors for ischemic stroke were analyzed.Results The CVHI score was 56.83±32.01 and 72.17±29.52 respectively and the modified FSP score was 17.22±4.12 and 11.03±3.65 respectively in LVH group(P<0.01).The cerebral blood velocity and volume were significantly lower while the peripheral resistance and pulse wave velocity were significantly higher in LVH group than in control group(P<0.05).The relative risk of LVH,CVHI and FSP score in predicting ischemic stroke was 1.69(95%CI:0.76-3.73),3.17(95%CI:1.81-5.54)and 1.35(95%CI:0.67-2.71)respectively.The CVHI score was an independent risk factor for ischemic stroke when the mutual influence of age,sex,and LVH,CVHI,FSP score on ischemic stroke was controlled.Conclusion LVH-related CVHI is an independent risk factor for ischemic stroke.
Objective To study the relationship of ECG-defined left ventricular hypertrophy(LVH)with cerebrovascular hemodynamic index(CVHI)and risk facrors for ischemic stroke.Methods A total of 1720 subjects with their age≥65 years from a cerebrovascular disease cohort in Fengxian District of Shanghai City were divided into LVH group(n=101)and control group(n=1619).Relationship of LVH,CVHI and Framingham stroke profile(FSP)score with risk factors for ischemic stroke were analyzed.Results The CVHI score was 56.83±32.01 and 72.17±29.52 respectively and the modified FSP score was 17.22±4.12 and 11.03±3.65 respectively in LVH group(P<0.01).The cerebral blood velocity and volume were significantly lower while the peripheral resistance and pulse wave velocity were significantly higher in LVH group than in control group(P<0.05).The relative risk of LVH,CVHI and FSP score in predicting ischemic stroke was 1.69(95%CI:0.76-3.73),3.17(95%CI:1.81-5.54)and 1.35(95%CI:0.67-2.71)respectively.The CVHI score was an independent risk factor for ischemic stroke when the mutual influence of age,sex,and LVH,CVHI,FSP score on ischemic stroke was controlled.Conclusion LVH-related CVHI is an independent risk factor for ischemic stroke.
引文
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[2]Ding SF,Ni M,Liu XL,et al.A causal relationship between shear stress and atherosclerotic lesions in apolipoprotein E knockout mice assessed by ultrasound biomicroscopy[J].Am J Physiol Heart Circ Physiol,2010,298(6):H2121-2129.DOI:10.1152/ajpheart.00308.2009.
[3]Hoi Y,Zhou YQ,Zhang X,et al.Correlation between local hemodynamics and lesion distribution in a novel aortic regurgitation murine model of atherosclerosis[J].Ann Biomed Eng,2011,39(5):1414-1422.DOI:10.1007/s10439-011-0255-Z.
[4]脑卒中高危人群筛检手段全国多中心扩展性试验课题组.脑卒中高危人群筛查手段的多中心前瞻性研究与评价[J].中华流行病学杂志,2008,29(2):105-109.DOI:10.3321/j.issn:0254-6450.2008.02.001.
[5]王艳,黄久仪,曹奕丰,等.上海市奉贤社区脑卒中危险因素队列研究基线调查和随访分析[J].中华流行病学杂志,2007,28(12):1171-1174.DOI:10.3760/j.issn:0254-6450.2007.12.005.
[6]O'Neal WT,Howard VJ,Kleindorfer D,et al.Interrelationship between electrocardiographic left ventricular hypertrophy,QT prolongation,and ischaemic stroke:the reasons for geographic and racial differences in stroke study[J].Europace,2016,18(5):767-772.DOI:10.1093/europace/euv232.
[7]Leigh JA,O'Neal WT,Soliman EZ.Electrocardiographic left ventricular hypertrophy as a predictor of cardiovascular disease independent of left ventricular anatomy in persons≥65years of age[J].Am J Cardiol,2016,117(11):1831-1835.DOI:10.1016/j.amjcard.2016.03.020.
[8]O'Neal WT,Almahmoud MF,Qureshi WT,et al.Electrocardiographic and echocardiographic left ventricular hypertrophy in the prediction of stroke in the elderly[J].J Stroke Cerebrovasc Dis,2015,24(9):1991-1997.DOI:10.1016/j.jstrokecerebrovasdis.2015.04.044.
[9]Edison ES,Yano Y,Hoshide S,et al.Association of electrocardiographic left ventricular hypertrophy with incident cardiovascular disease in Japanese older hypertensive patients[J].Am J Hypertens,2015,28(4):527-534.DOI:10.1093/ajh/hpu184.
[10]Wang S,Xue H,Zou Y,et al.Left ventricular hypertrophy,abnormal ventricular geometry and relative wall thickness are associated with increased risk of stroke in hypertensive patients among the Han Chinese[J].Hypertens Res,2014,37(9):870-874.DOI:10.1038/hr.2014.88.
[11]郭吉平,黄久仪,管阳太,等.脑血流动力学改变与脑卒中发病关系的队列研究[J].中华预防医学杂志,2013,47(4):323-327.DOI:10.3760/cma.j.issn.0253-9624.2013.04.008.