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Cardiovascular care for older adults： hypertension and stroke in the older adult

Journal of Geriatric Cardiology 2016年第5期13卷 373-379页

作者： Andrew P Miller Ann M Navar Gary S Roubin suzanne oparil CardioVascular Associates Birmingham Alabama USA Duke Clinical Research Institute Durham North Carolina USA Vascular Biology & Hypertension Program Division of Cardiovascular Disease University of Alabama at Birmingham Birmingham Alabama USA

Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.

关键词：高血压老年人心血管中风护理年龄相关血管功能脑血管疾病

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Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study

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Journal of Biomedical Science and Engineering 2015年第3期8卷 213-225页

作者： Robert W. W. Biederman Alistair A. Young Mark Doyle Richard B. Devereux Eduardo Kortright Gilbert Perry Jonathan N. Bella suzanne oparil David Calhoun Gerald M. Pohost Louis J. Dell’Italia Division of Cardiology Department of Cardiovascular CMR Gerald McGinnis Cardiovascular Institute Allegheny General Hospital Drexel University College of Medicine Pittsburgh USA University of Auckland Auckland New Zealand Weill Cornell Medical College New York USA ACTEK Inc. Birmingham USA University of Alabama at Birmingham Birmingham USA Albert Einstein College of Medicine Bronx USA University of Southern California Los Angeles USA

Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P P P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P P P 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.

关键词： Hypertension Left Ventricular Hypertrophy Magnetic Resonance Imaging Cardiac Mechanics Heart Wall Motion 3D

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