三维超声心动图评价高血压左心室肥厚消退治疗的临床研究

目的　探讨三维超声心动图评价左心室肥厚消退的价值。方法　 96例高血压合并左心室肥厚的患者随机分为雷米普利、氯沙坦和二者联合用药治疗组 ,用药 6个月后复查 ,分别采用M型、二维超声心动图和动态三维超声心动图评价用药前后左心室质量 (LVM)的变化。结果　治疗 6个月后 ,雷米普利组、氯沙坦组及联合用药组M型超声和二维超声测得的LVM分别下降了 16.9% ,17.9%和 18.8% ,三维超声测得的LVM分别减少了 11.6% ,14 .7%和 13 .6% ;三维超声测得的LVM用药前后的差值显著小于M型超声和二维超声的测值 (P<0 .0 5 )。结论　应用M型超声和二维超声评价高血压左心室肥厚 (LVH)的消退 ,会高估药物疗效 ,三维超声能更准确地评价药物对高血压左心室肥厚消退的作用。

Regression of left ventricular hypertrophy with ramipril and losartan: assessment by three-dimensional echocardiography

Objective To compare the reduction in left ventricular hypertrophy (LVH) caused by monotherapy with ramipril or losartan or the combination of these two drugs,in patients with hypertensive LVH and to evaluate the value of three-dimensional echocardiography (3DE) on LVH regression.Methods Ninety-six essential hypertensive patients with LVH were enrolled in this study.All patients were randomly divided into 3 groups: ramipril group,losartan group,combination group with ramipril and losartan.Left ventricular mass(LVM) was calculated by M-mode echocardiography,two-dimensional echocardiography and 3DE at baseline and after 6 months treatment with ramipril or losartan.Results Of 96 patients enrolled,59 patients have complete follow-up datum.LVM of ramipril,losartan and combination group decreased 16.9% , 17.9% and 18.8% compared with before treatment.LVM by 3DE decreased 11.6% , 14.7% and 13.6% respectively.The difference of LVM derived from 3DE showed obviously lower than derived from M-mode echocardiography.Conclusions Applying M-mode echocardiography and two-dimensional echocardiography to evaluate the regression of LVH will overestimate the effects of drugs.Three-dimensional echocardiography may detect the changes of LVM more accurately.