RESUMEN
To evaluate right atrial ( RA ) structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome ( OSAS ) by real‐time three‐dimensional echocardiography ( RT‐3DE) . Methods One hundred and ninety‐nine patients with habitual snoring were diagnosed as OSAS by polysomnography with apnea hypopnea index ≥ 5/h . Fifty gender ,age matching healthy people were selected as control group . Blood pressure and general clinical characteristics were collected and echocardiography was performed next morning . On the basis of left ventricular mass index , relative wall thickness ,left ventricular end‐diastolic diameter ,patients were divided into 6 groups :normal geometry ( NG) ,concentric remodeling ( CR) ,eccentric non dilated hypertrophy ( ND‐EH ) ,concentric non dilated hypertrophy ( ND‐CH ) ,eccentric dilated hypertrophy ( D‐EH ) ,and concentric dilated hypertrophy ( D‐CH) .Full volume images at apical four‐chamber view were collected . Right atrial volume‐time curve , RA maximum volume ( RAVmax ) , RA minimum volume ( RAVmin ) , RA pre‐contraction volume ( RAVpre‐a) were analyzed with QLab workstation . Following parameters including RA total emptying volume ( RA TotEV ) , RA total emptying fraction ( RA TotEF ) , RA passive emptying volume ( RA PassEV ) ,RA passive emptying fraction ( RA PassEF) ,RA active emptying volume ( RA ActEV ) ,RA active emptying fraction ( RA ActEF) were calculated . All structural parameters were corrected by BSA . Results①RA structural parameters :compared with control and NG groups ,RAVmax ,RAVmin ,RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH+ EH) groups ( P ＜0 .05) . Compared with control ,NG and CR groups ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups , RAVmax , RAVmax/BSA , RAVmin , RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH and D‐( CH+EH ) groups( P ＜0 .05) . Compared with control , NG ,CR and ND‐EH groups ,RAVmax ,RAVmax/BSA ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH ,D‐( CH+EH) groups ,RAVmin and RAVmin/BSA were increased in D‐( CH+ EH ) group ( P ＜0 .05) . Compared with control ,NG ,CR ,ND‐EH and ND‐CH groups ,RAVpre‐a and RAVpre‐a/BSA were increased in D‐( CH + EH ) group ( P ＜ 0 .05 ) . ② RA reservoir function parameters :compared with control ,NG and CR groups ,RA TotEV was increased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05 ) . Compared with control ,NG ,CR and ND‐EH groups ,RA TotEV was increased in D‐( CH + EH ) group ( P＜0 .05) . ③ RA conduit function parameters :compared with control ,NG and CR groups ,RA PassEF was decreased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups ,RA PassEV was decreased in ND‐CH and D‐( CH+EH) groups( P ＜0 .05) . Compared with control ,NG ,CR and ND‐EH groups ,RA PassEV was decreased in D‐( CH+EH) group ,RA PassEF was decreased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05) . ④ RA pump function parameters :compared with control ,NG and CR groups ,RA ActEF were increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05 ) ; Compared with control ,NG ,CR and ND‐EH groups ,RA ActEV was increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05) . Conclusions Different left ventricular geometric patterns have different RA structure and function in OSAS ,patients with ND‐CH and D‐( CH + EH ) have worse RA structure and function . T he results of this study suggested that the clinical need to pay attention to the RA structure and function of OSAS patients with dilated LV H .
RESUMEN
El presente trabajo fue diseñado para analizar ecocardiográficamente la geometría del ventrículo izquierdo en ratas espontáneamente hipertensas (SHR). Se estudiaron 114 ratas macho de 4 meses de edad, 73 SHR y 41 Wistar (W) a las que se les registró la presión arterial, la frecuencia cardíaca y se les realizó un ecocardiograma. Con las mediciones de diámetros y espesores de la pared ventricular izquierda se calcularon el espesor parietal relativo (h/r), el índice de masa del ventrículo izquierdo (IMVI), el volumen minuto, y el acortamiento medio ventricular. La geometría ventricular izquierda normal fue definida analizando el grupo de ratas normotensas y fijando los límites de IMVI y h/r a partir de la media más 2 desvíos estándar. Los patrones de geometría anormal se definieron como: remodelado concéntrico (RC): IMVI < 2.06 mg/g - h/r > 0.71; hipertrofia excéntrica (HE): IMVI>2.06 mg/g - h/r<0.71 e hipertrofia concéntrica (HC): IMVI > 2.06 mg/g - h/r > 0.71. La presión arterial sistólica y el volumen minuto se utilizaron para estimar la resistencia periférica total (RPT). Doce por ciento de SHR presentaron geometría ventricular izquierda normal; 18% RC; 33% HC y 37% HE. El RC mostró el volumen latido más pequeño y la RPT más alta de cualquier grupo. HE presentó presión arterial sistólica similar a la de los otros grupos de SHR, volumen latido más alto y la RPT más baja. Estos hallazgos en SHR exhibiendo diferentes patrones de geometría ventricular izquierda, similares a los referidos en humanos, intensifican las similitudes entre la hipertensión esencial humana y las SHR.
The purpose of this study was to analyze by echocardiogram left ventricular (LV) geometry in spontaneously hypertensive rats (SHR). Echocardiographic study, systolic blood pressure and heart rate were obtained in 114 male, 4-month old rats, 73 SHR and 41 Wistar (W). Left ventricular mass index (LVMI), relative wall thickness (RWT), stroke volume, and mid ventricular shortening were calculated with echocardiographic parameters. Normal LV was defined considering the mean plus 2 SD of LVMI and RWT in W. Patterns of abnormal LV geometry were: LV concentric remodeling, LVMI < 2.06 mg/g - RWT > 0.71; eccentric, left ventricular hypertrophy (LVH), LVMI > 2.06 mg/g - RWT < 0.71; and concentric LVH, LVMI > 2.06 mg/g - RWT > 0.71. Systolic blood pressure (SBP) and cardiac output (CO) were used to obtain total peripheral resistance (TPR). twelve % of SHR had normal LV geometry; 18% LV concentric remodeling; 33% concentric LVH and 37% eccentric LVH. LV concentric remodeling showed the smallest CO and highest TPR of any group. Eccentric LVH presented similar SBP as the other SHR groups and high CO with lower TPR. Our findings in SHR exhibit different patterns of LV geometry like in humans. These results strengthen the similarities between SHR and human essential hypertension.