Comparison of Left Ventricular Hypertrophy, Fibrosis and Dysfunction According to Various Disease Mechanisms such as Hypertension, Diabetes Mellitus and Chronic Renal Failure
2
조회
0
다운로드
0
인용
0
참고문헌
초록
Background: Left ventricular hypertrophy (LVH) has been known as an important predictor of prognosis of cardiovascular disease. Carboxy-terminal propeptide of procollagen type I (PIP) is related with myocardial fibrosis. We sought to analyze the differences in the characteristics of LVH, myocardial fibrosis, and LV functions among hypertension (HBP), diabetes mellitus (DM) and chronic renal failure (CRF). Methods: We enrolled consecutive patients with LVH. Patients were grouped as HBP (n=50), DM (n=41), CRF (n=31). Age and sex-matched normal control was also enrolled (n=32). Echocardiography and blood sampling for serum PIP level measuring was performedin all participants. Results: There were no differences in baseline characteristics except systolic blood pressure among four groups. In three patients groups, their LV mass indices were significantly increased than control. Serum PIP level in CRF was much higher than others (CRF 1505.5 vs. HBP 868.7 vs. DM 687.5 vs. control 826.4, p<0.0001). LV diastolic and systolic function evaluated by E’, E/E, S’ and midwall fractional shortening was significantly decreased in three patients groups. However, LAVi was significantly elevated and LV ejection fraction was significantly decreased in CRF compared to others. In correlation analysis, indices of diastolic function were weakly, but statistically correlated with PIP (E’: r=0.234, p=0.006; LAVi: r=0.231, p=0.006). Conclusion: In CRF, LV function was more deteriorated and serum PIP was more elevated when compared to HBP or DM. Therefore, myocardial fibrosis may play an important role to LV dysfunction as well as LV hypertrophy in CRF in some degree.
Abstract
Background: Left ventricular hypertrophy (LVH) has been known as an important predictor of prognosis of cardiovascular disease. Carboxy-terminal propeptide of procollagen type I (PIP) is related with myocardial fibrosis. We sought to analyze the differences in the characteristics of LVH, myocardial fibrosis, and LV functions among hypertension (HBP), diabetes mellitus (DM) and chronic renal failure (CRF). Methods: We enrolled consecutive patients with LVH. Patients were grouped as HBP (n=50), DM (n=41), CRF (n=31). Age and sex-matched normal control was also enrolled (n=32). Echocardiography and blood sampling for serum PIP level measuring was performedin all participants. Results: There were no differences in baseline characteristics except systolic blood pressure among four groups. In three patients groups, their LV mass indices were significantly increased than control. Serum PIP level in CRF was much higher than others (CRF 1505.5 vs. HBP 868.7 vs. DM 687.5 vs. control 826.4, p<0.0001). LV diastolic and systolic function evaluated by E’, E/E, S’ and midwall fractional shortening was significantly decreased in three patients groups. However, LAVi was significantly elevated and LV ejection fraction was significantly decreased in CRF compared to others. In correlation analysis, indices of diastolic function were weakly, but statistically correlated with PIP (E’: r=0.234, p=0.006; LAVi: r=0.231, p=0.006). Conclusion: In CRF, LV function was more deteriorated and serum PIP was more elevated when compared to HBP or DM. Therefore, myocardial fibrosis may play an important role to LV dysfunction as well as LV hypertrophy in CRF in some degree.
참고문헌 (32)
- Díez J, "Mechanisms of disease: pathologic structural remodeling is more than adaptive hypertrophy in hypertensive heart disease", Nat Clin Pract Cardiovasc Med, 2, pp.209~216 (2005)
- Devereux RB, "Impact of diabetes on cardiac structure and function: the strong heart study", Circulation, 101, pp.2271~2276 (2000)
- Guerin AP, "Cardiovascular disease in renal failure", Minerva Urol Nefrol, 56, pp.279~288 (2004)
- Aurigemma GP, "Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy", J Am Coll Cardiol, 26, pp.195~202 (1995)
- Levy D, "Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study", N Engl J Med, 322, pp.1561~1566 (1990)
- Casale PN, "Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men", Ann Intern Med, 105, pp.173~178 (1986)
- Rossi MA, "Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans", J Hypertens, 16, pp.1031~1041 (1998)
- Ciulla M, "Echocardiographic patterns of myocardial fibrosis in hypertensive patients: endomyocardial biopsy versus ultrasonic tissue characterizatien", J Am Soc Echocardiogr, 10, pp.657~664 (1997)
- Querejeta R, "Serum cardoxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease", Circulation, 101, pp.1729~1735 (2000)
- Díez J, "Serum markers of collagen type I metabolism in spontaneously hypertensive rats: relation to myocardial fibrosis", Circulation, 93, pp.1026~1032 (1996)
- López B, "Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of antihypertensive treatment in hypertensive patients", Circulation, 104, pp.286~291 (2001)
- Sahn DJ, "Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements", Circulation, 58, pp.1072~1083 (1978)
- Schiller NB, "Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms", J Am Soc Echocardiogr, 2, pp.358~367 (1989)
- Teichholz LE, "Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy", Am J Cardiol, 37, pp.7~11 (1976)
- 임상현, "초기 제 2 형 당뇨병환자에서 심근 섬유화의 지표인 혈중 Carboxy-Terminal Propeptide of Type 1Procollagen(PIP)과 좌심실 이완기능의 연관성", Korean Circulation Journal, 35(7), pp.500~506 (2005), 대한심장학회
- Koren MJ, "Mechanism, effects, and reversal of left ventricular hypertrophy in hypertension", Curr Opin Nephrol Hypertens, 2, pp.87~95 (1993)
- Taegtmeyer H, "Adaptation and maladaptation of the heart in diabetes: part I: general concepts", Circulation, 105, pp.1727~1733 (2002)
- Young ME, "Adaptation and maladaptation of the heart in diabetes: part II: potential mechanisms", Circulation, 105, pp.1861~1870 (2002)
- Candido R, "A breaker of advanced glycation end products attenuates diabetes-induced myocardial structural changes", Circ Res, 92, pp.785~792 (2003)
- Brownlee M, "Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications", N Engl J Med, 318, pp.1315~1321 (1988)
- Ha SK, "Prevalence and patterns of left ventricular hypertrophy in patients with predialysis chronic renal failure", J Korean Med Sci, 13, pp.488~494 (1998)
- Ulasi II, "Left ventricular hypertrophy in African Black patients with chronic renal failure at first evaluation", Ethn Dis, 16, pp.859~864 (2006)
- Vlahakos DV, "Relationship between left ventricular hypertrophy and plasma renin activity in chronic hemodialysis patients", J Am Soc Nephrol, 8, pp.1764~1770 (1997)
- Weber KT, "Pathologic hypertrophy with fibrosis: the structural basis for myocardial failure", pp.75~85 (1992), Blood Press
- Nicoletti A, "Cardiac fibrosis and inflammation: interaction with hemodynamic and hormonal factors", Cardiovasc Res, 41, pp.532~543 (1999)
- Rix M, "Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure", Kidney Int, 56, pp.1084~1093 (1999)
- Coen G, "Procollagen type I Cterminal extension peptide in predialysis chronic renal failure", Am J Nephrol, 12, pp.246~251 (1992)
- Ha SK, "Studies on bone markers and bone mineral density in patients with chronic renal failure", Yonsei Med J, 37, pp.350~356 (1996)
- Yoon SJ, "Fibrillar collagen turnover index - The clinical importance in the assessment of ventricular hypertrophy and diastolic function in hypertensive patients", Korean Hypertension J, 13, pp.32~40 (2007)
- Cheong ER, "LV mass and left ventricular systolic function after antihypertensive therapy", J Kor Soc Echo, 2, pp.187~191 (1994)
- Son KH, "Assessment of left ventricular mass and diastolic function in patients with essential hypertension after one year antihypertensive therapy", J Kor Soc Echo, 2, pp.71~79 (1994)
- 이혜진, "말기부전증 환자에서 신장이식술 전후의 심초음파 변화에 관한 연구 -좌심실 구혈율과 좌심실 질량변화를 중심으로-", Journal of Cardiovascular Ultrasound, 8(1), pp.31~35 (2000), 한국심초음파학회