超声心动图评价高血压患者的左心房构型和功能变化

目的：采用超声心动图二维、M型和脉冲多普勒技术,评价高血压患者左心房（LA）构型及功能的改变。方法：选择高血压患者61例,另设33名体检者作为正常对照组。所有研究对象皆同期行超声心动图检查（二维,M型和脉冲检查均正常）,且无高血压病史。将61例高血压病患者根据M型超声心动图常规标准分为LA不大组（n=30）和LA增大组（n=31）,再采用二维超声和多普勒测量3组的LA构型指标[左心房舒张期内径（LADd）、左心房内径指数（LADi）、左心房容积（LAV）、左心房舒张期容积指数（LADVi）]及功能指标[左心房射血量（LASV）、左心房射血分数（LAEF）、左心房排空指数（LAEi）、左心房射血力（LAF）、左心房灌注分数（LAFF）]。结果：与正常对照组相比,LA不大组的多项LA构型指标均有改变,且差异有统计学意义（P均〈0.05）,包括LADd、LADi升高,LAFF增高[（40.79±5.37）%比（37.68±4.56）%]。而LA增大组的各项LA构型及功能指标均高于正常对照组和LA不大组,且差异有统计学意义（P均〈0.05）。结论：常规M型超声心动图诊断为LA不大的早期高血压患者,已发生LA构型及舒张功能异常;常规超声诊断LA增大患者,其LA异常进一步加重。二维超声和多普勒检查有助于检出高血压患者的早期LA损害,并评估其损害的严重程度。

Evaluation of left atrial geometry and function by echocardiography in hypertensive patients

Objective To detect left atrial （LA） geometric and functional changes in hypertensive patients by 2-D, M-mode, and Doppler echocardiography. Methods Thirty-three normal control subjects and 61 hypertensive patients were studied. The hypertensive patients were divided into two groups according to the LA diameter measured by M-mode method. Patients in group A （n=30） had a LA ≤40 mm and in group B （n=31） had a LA 〉 40 mm. LA geometric parameters [left atrial diastolic diameter （LADd）, left atrial diameter index （LADi）, left atrial volume （LAV）, left atrial diastolic volume index （LADVi）] and LA functional parameters [left atrial stroke volume （LASV）, left atrial ejection fraction （LAEF）, left atrial emptying index （LAEi）, left atrial ejection force （LAF）, left atrial flow fraction （LAFF）] were measured. Results Compared with normotensive control group, patients in group A had abnormal geometric parameters including elevation of LADd and LADi （P〈0.05） and a significantly increased LAFF [（40.79±5.37）% vs （37.68±4.56）%, P〈0.05]. All the LA geometric and functional parameters in group B were significantly higher than both the control group and group A （all P〈 0.05）. Conclusions Patients classified as having not enlarged LA according to routine M-mode method have already had LA geometric changes and impaired LA diastolic function. Whereas patients diagnosed as having enlarged LA have more severe LA geometric and functional abnormalities. The new 2-D and Doppler echocardiographic parameters can be used to detect early LA geometric and functional changes and to assess the severity of these changes in hypertensive patients.