老年原发性高血压患者左心房/左心室容量比值的变化

目的本文旨在探讨老年原发性高血压患者左心房容量／左心室容量比值变化的临床意义。方法老年正常对照组32例。老年原发性高血压无室壁肥厚患者35例，老年原发性高血压患者伴室壁肥厚者33例。应用实时三维三平面显像方式测量左房、左室容量，对3组病人的左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值进行分析。结果左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值在高血压室壁肥厚组与对照组之间均存在极显著差异（P〈0．01），但左房内径在原发高血压无室壁肥厚组与对照组之间无显著差异（P〉0．05）。左房容量、左房容量指数在原发高血压无室壁肥厚组与对照组之间差异有显著性（P〈0．05），左心房容量／左心室容量比值在原发高血压无室壁肥厚组与对照组之间差异更为显著（P〈0．01）且变异性最小。结论左心房容量／左心室容量比值是一种新的参数，能够灵敏地反映老年原发性高血压患者舒张功能减低的血流动力学改变。     

实时三维超声心动图评价高血压患者左心室心肌质量及左心房功能

目的应用实时三维超声心动图技术评价高血压患者左心室质量、左心房功能,并对左心室质量的测量与常规M型方法进行对照。方法在37名健康人、39例高血压无左心室肥厚(NLVH)患者和27例高血压伴左心室肥厚(LVH)患者中进行了超声心动图检查。应用M型超声心动图测量左心室质量(LVM)并计算左心室质量指数(LVMI),实时三维超声测量左心室质量(LVM)及LVMI,左心房舒张末容积(LAEDV)、左心房收缩末容积(LAESV),左心房射血分数(LAEF),并比较高血压组(NLVH组、LVH组)与健康对照组之间的差异。结果对照组、高血压NLVH组、LVH组3组间左心室质量指数两种检测方法差异均具有统计学意义(P<0.05),并且发现三维超声检测结果较M型测量数值低。左心房收缩功能指标各组间差异均有统计学意义(P<0.05)。在左心室重构、心肌质量增大的高血压患者,左心房容积增大,而收缩功能减低。结论实时三维超声技术能够定量评价高血压患者左心房功能,测量左心室质量。     

原发性高血压左心房应变率与左心室舒张功能的相关性研究

目的探讨原发性高血压患者左心房应变率与左心室舒张功能的关系。方法选取2012年1月—2013年1月我院心内科、老年医学科收治的原发性高血压患者142例,根据舒张功能将患者分为Ⅰ组(正常充盈组,42例)、Ⅱ组(松弛性减低组,48例)、Ⅲ组(充盈假性正常化组,32例)、Ⅳ组(限制性充盈障碍组,20例)。观察4组患者左房室瓣血流舒张晚期A峰峰值流速(A)、A峰速度-时间积分(A-VTI)、舒张早期充盈时间(EDT)、等容舒张时间(IVRT)、E/A、左房射血力(AEF)。测量心室收缩期左房峰值应变率(SRs)、心室舒张早期左房峰值应变率(SRe)及心房收缩期左房峰值应变率(SRa)。结果Ⅲ组和Ⅳ组A、A-VTI均高于Ⅰ组,Ⅱ组、Ⅲ组和Ⅳ组EDT、IVRT均高于Ⅰ组,Ⅱ组和Ⅳ组E/A均高于Ⅰ组,Ⅳ组AEF高于Ⅰ组(P0.05)。Ⅱ组、Ⅲ组和Ⅳ组SRs、Sra高于Ⅰ组,Ⅲ组和Ⅳ组Sre高于Ⅰ组(P0.05)。结论左心房应变率与左心室舒张功能密切相关,对高血压的病情评估、疗效观察和预后判断有重要的临床意义,可为临床诊疗提供有利的依据。     

肾功能异常对恶性高血压患者心脏结构与功能的影响

目的:评估肾功能异常对恶性高血压患者心脏结构与功能的影响。方法:恶性高血压患者根据肾功能分为肾功能正常组(31例)和肾功能异常组(32例),测量左心室重量(LVM)、重量指数(LVMI)、左室舒张末内径(LVEDd)、室间隔厚度(IVST)、相对室壁厚度(RWT)左室后壁厚度(LVPWT)以及左心室舒张早期二尖瓣最大血流速度(E峰)与舒张晚期二尖瓣最大血流速度(A峰)、E/A比值和左室射血分数(LVEF)等心脏功能指标。结果:与肾功能正常组比较,肾功能不全组IVST[(11.6±1.9)mm比(13.0±2.0)mm]、LVPWT[(10.6±1.9)mm比(12.7±1.4)mm]、LVEDd[(48.4±6.6)mm比(52.5±3.9)mm]、RWT[(0.44±0.08)mm比(0.51±0.07)mm]、LVM[(208.1±77.5)g比(264.2±63.1)g]、LVMI[(114.5±39.2)g/m2比(152.6±39.0)g/m2],左室肥厚比例(25.0%比85.7%)明显增加(P<0.05),而LVEF、E/A差异则无显著性(P>0.05)。结论:肾功能不全患者左心室肥厚较肾功能正常患者更加明显,而收缩、舒张功能指标改变差别不显著。     

实时三维超声心动图测量左心房功能相关参数及其应用价值

目的应用实时三维超声心动图(RT-3DE)探讨健康人左心房容积及功能相关参数的正常值及其应用价值。方法选取202名健康志愿者,按性别分为男性组和女性组,按年龄分为A组≤40岁(63名),B组41⁶0岁(87名),C组>60岁(52名)。应用RT-3DE技术获得左心房最大容积(LAEDV)、左心房最小容积(LAESV)、左心房射血量(LASV)、左心房收缩前容积(LApre)、左心房被动排空容积(LAVp)、左心房主动排空容积(LAVa)和左心房射血分数(LAEF),并对参数用体表面积校正,得出标化LAEDVI、LAESVI、LASVI、LApreI、LAVpI、LAVaI、LAEF',统计分析得到上述参数正常值区间范围,并比较各年龄组及性别组之间的差异。结果 202名健康志愿者LAEDVI为(32.5860岁(87名),C组>60岁(52名)。应用RT-3DE技术获得左心房最大容积(LAEDV)、左心房最小容积(LAESV)、左心房射血量(LASV)、左心房收缩前容积(LApre)、左心房被动排空容积(LAVp)、左心房主动排空容积(LAVa)和左心房射血分数(LAEF),并对参数用体表面积校正,得出标化LAEDVI、LAESVI、LASVI、LApreI、LAVpI、LAVaI、LAEF',统计分析得到上述参数正常值区间范围,并比较各年龄组及性别组之间的差异。结果 202名健康志愿者LAEDVI为(32.58³5.05)ml/m2,LAESVI为(14.8035.05)ml/m2,LAESVI为(14.80¹6.21)ml/m2,LASVI为(17.8716.21)ml/m2,LASVI为(17.87¹9.40)ml/m2,LApreI为(17.9919.40)ml/m2,LApreI为(17.99¹9.86)ml/m2、LAVpI为(10.4619.86)ml/m2、LAVpI为(10.46¹1.92)ml/m2、LAVaI为(6.8811.92)ml/m2、LAVaI为(6.88⁷.92)ml/m2、LAEF'为53.54%7.92)ml/m2、LAEF'为53.54%⁵5.95%。男性组与女性组比较LAEDVI、LAESVI、LASVI、LApreI、LAVpI、LAVaI、LAEF'值差异无统计学意义(均为P>0.05)。不同年龄组间比较LAEDVI、LAESVI、LASVI、LApreI、LAVpI、LAVaI值差异有统计学意义(均为P<0.05),LAEF'值随年龄增加呈递减趋势,但差异无统计学意义(均为P>0.05)。结论 RT-3DE技术在评价左心房容积及功能方面是可行的,并初步建立了健康人左心房容积与功能相关参数的医学参考值,为临床评估左心房结构和功能提供参考。     

实时三维超声心动图评价心肌梗死患者左心房功能

目的应用实时三维超声心动图技术评价心肌梗死患者左心房功能改变。方法分别对37例陈旧性心肌梗死患者和50名健康人进行二维超声心动图和三维超声心动图检查。测量左心房射血分数(LAEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)、二尖瓣E/e'。采用成组t检验比较两组指标。结果与健康组比较,心肌梗死患者左心室容积、左心房内径、二尖瓣环内径、二尖瓣E/e'和LAEF[(11.5±5.6)kdyne比(4.8±2.7)kdyne]均明显增加(均为P<0.05)。结论实时三维超声心动图技术能够用以评价左心房功能。左心室功能减低的心肌梗死患者表现为左心房收缩功能代偿增强。     

原发性高血压患者左房射血力与左室舒张功能的研究

目的:研究原发性高血压(EH)患者左房射血力(LAF)与左室舒张功能的关系.方法:对23例EH患者(EH组)和20例正常者(对照组)的超声心动图参数进行检测.结果:EH组的E峰速率与对照组比较无显著性差异,而A峰速率及LAF两组间有极显著性差异[(84.50±16.50) cm/s∶(63.21±10.78) cm/s,P<0.01;(17.40±7.20)∶(8.19±3.11)kdynes, P<0.001].结论:E峰由于受多种因素影响不宜用于衡量舒张功能.而A峰影响因素较少,LAF主要由A峰推导出来反映左房增力泵作用的比较直观的指标,更适用于尚未引起肥厚的轻中度EH患者早期舒张功能减退的识别.     

高血压患者左室舒张功能与内皮素的相关性

以往内皮素(ET)与左心室收缩功能关系的研究报道较多，而与左心室舒张功能关系的研究较少。本研究探讨评价高血压患者血浆ET与左心室舒张功能的关系。     

壮族原发性高血压左心室肥厚患者不同心电图诊断指标的应用价值

目的探讨不同心电图诊断指标在壮族原发性高血压患者左心室肥厚临床诊断中的应用价值。方法选择壮族原发性高血压患者100例,以超声心动图检查所得到的左心室质量指数作为左心室肥厚诊断的参考标准,验证Cornell指数、Sokolow-Lyon指数和Romhilt-Estes积分3种心电图诊断指标的临床应用价值。结果以超声心动图诊断的左心室肥厚结果为标准,3种心电图指标均存在敏感性低,特异性高的特点;男性的诊断价值均大于女性;Romhilt-Estes积分高于Cornell指数和Sokolow-Lyon指数(P0.05)。结论 3种心电图指标可以作为诊断左心室肥厚的常规方法。     

原发性高血压患者左心室功能的临床研究

目的探讨原发性高血压患者左心室功能的临床研究。方法原发性高血压患者176例,按Ganau法分为4型:正常构型组(A组)46例、向心性重构组(B组)53例、向心性肥厚组(C组)40例、离心性肥厚组(D组)37例;正常对照组35例。超声心动图测量舒张末室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径,二尖瓣血流频谱左心室舒张早期血流峰速(E),舒张晚期血流峰速(A)值比,左心室射血分数(LVEF)及Tei指数。各组血浆脑钠肽(BNP)浓度对比分析。结果正常对照组与高血压各组比较,在年龄、性别均差异无显著性意义,C组、D组收缩压最高,左心房内径最大(P<0.05);B组、D组IVS、LVPW轻度增厚(P<0.05);高血压各组的E/A值均降低(P<0.05),LVEF值只有D组与正常对照组比较差异有显著性意义;各组Tei指数差异有显著性意义;BNP在B组、C组、D组差异有显著性意义。结论Tei指数,BNP共同评价原发性高血压患者不同左心室构型的心功能情况,对原发性高血压的治疗效果和预后有临床应用价值。     

Mechanism of left a trial enlargement related to ventricular diastolic impairment in hypertension

Background and hypothesis: Systemic hypertension is the leading cause of left ventricular (LV) hypertrophy. The present study aimed to investigate the mechanism of left atrial (LA) enlargement in patients with hypertensive heart disease during cardiac catheterization. Methods: Data were obtained from eight control subjects and seven patients with hypertensive heart disease. Left atrial and LV pressures from catheter-tip micromanometer, and LA and LV volumes from biplane cineangiograms were analyzed during the same cardiac cycle. Results: Left atrial maximal volume were 93 ± 26 ml in patients with hypertensive heart disease and 63 ± 12 ml in control subjects (p<0.05). In patients with hypertensive heart disease, time constant of LV relaxation was significantly greater than that in controls (54 ± 18 vs. 31 ± 16 ms, respectively p<0.01). Left atrial maximal volume correlated with time constant of LV relaxation (r = 0.86, p<0.01). The ratio of LV filling volume before LA contraction to LV stroke volume in patients with hypertensive heart disease was significantly lower than that in control subjects (65 ± 13 vs. 76 ± 7%, respectively p<0.05). On the other hand, the ratio of LV filling volume during LA contraction to stroke volume in patients with hypertensive heart disease was significantly higher than that in controls (35 ± 13 vs. 24± 7%, respectively p<0.05). Left atrial volume before LA contraction in patients with hypertensive heart disease was significantly larger than that in controls (74 ± 22 vs. 47 ± 10 ml, respectively, p<0.01). During LA contraction, LA work was significantly increased in patients with hypertensive heart disease compared with that in controls (274 ± 101 vs. 94 ± 42 mmHg. ml, respectively p<0.001). Left atrial work showed significant correlation with LA volume before LA contraction (r = 0.75, p <0.01). Conclusion: Left ventricular diastolic filling was impaired in patients with hypertensive heart disease. Enlargement of left atrium might be attributed to the impairment of blood flow from left atrium to left ventricle due to the increased LV stiffness.     

Reassessment of electrovectorcardiographic signs of left atrial enlargement

Echocardiographic left atrial size was correlated with 27 electrovectorcardiographic parameters in 93 subjects. In 20 of them hemodynamic studies, including calculation of the left atrial volume, were performed. Subjects were divided into four groups as follows: Group I, 21 healthy subjects; group II, 45 patients with heart disease but no left atrial enlargement; group III, 15 patients with heart disease and left atrial size from 4.1 to 5 cm; and group IV, 12 patients with heart disease and a left atrial size exceeding 5 cm. A good correlation was found between left atrial size and the following parameters: Duration of P wave in standard lead II, voltage of both terminal forces of P wave in lead V1 and its maximal vector in the frontal and sagittal planes. A new index (duration/voltage of P wave in lead II) was postulated, which showed an excellent correlation with left atrial size (p less than 0.001). In all cases the superposition between groups was excessive. These findings indicate the limitations of the classical patterns and raise interest in new parameters concerning the electrocardiographic diagnosis of left atrial enlargement.     

心钠素基因多态性与原发性高血压患者左心室肥厚的关系

目的 探讨人类心钠素（ANP）基因多态性与原发性高血压患者左心室肥厚的关系.方法 选择原发性高血压患者106例,根据心脏超声检查结果分为单纯高血压组（对照组）75例和高血压合并左心室肥厚组（观察组）31例,采用PCR技术检测人类ANP基因C664G、G1837A和T2238C位点的多态性,比较两组基因型及等位基因分布差异.结果 观察组患者人类ANP基因C664G位点GG基因型频率为54.8％,高于对照组的33.3％（P＜0.05）.两组患者人类ANP基因G1837A位点和T2238C位点基因型和各等位基因频率差异无统计学意义.结论 人类ANP基因C664G位点的基因变异可能与原发性高血压患者左心室肥厚有关.     

Hypertriglyceridemic waist phenotype is associated with left ventricular hypertrophy in Chinese hypertension patients

Left ventricular hypertrophy (LVH), the most common target organ damage in patients with hypertension, is closely related to excessive visceral adipose tissue (VAT) accumulation in the body. The hypertriglyceridemic waist (HTHW) phenotype can act as a surrogate marker of excessive VAT. However, the relationship between the HTHW phenotype and LVH in patients with hypertension remains unknown. The present study aimed to investigate whether the HTHW phenotype is associated with LVH, using echocardiography in a cross-sectional study involving 4470 middle-aged and older Chinese patients with hypertension. Logistic regression analysis revealed that patients with the HTHW phenotype were 1.52-fold more likely to experience LVH than those with normal triglyceride levels and normal waist circumference. This association was independent of age, sex, and other potentially confounding factors. In the stratified analysis, a stronger correlation was found among women, people of at least 70 years of age, and people with hyperuricemia. These results suggest that distinguishing the HTHW phenotype in patients with hypertension could serve as a simple and effective screening strategy for identifying people with a higher risk of developing LVH.     

Significance of echocardiographic left atrial enlargement in aortic stenosis

This study investigated the significance of echocardiographic left atrial enlargement as measured by the left atrial dimension corrected for body surface area in 24 patients with pure aortic stenosis established by cardiac catheterization. Echocardiographic evidence of left atrial enlargement occurred in 11 of 15 patients (73%) with an aortic valve area below 0.8 cm2 and in none of nine patients (0%) with an aortic valve area above 0.8 cm2, p less than 0.0025. All 11 patients (100%) with an enlarged left atrial dimension had an increased diastolic left ventricular dimension, whereas 1 of 13 patients (8%) with a normal left atrial dimension had an increased diastolic left ventricular dimension, p less than 0.00001. The 11 patients (100%) with an enlarged left atrial dimension had increased posterior left ventricular wall thickness, whereas 2 of 13 patients (13%) with a normal left atrial dimension had increased posterior left ventricular wall thickness (p less than 0.0005). These data lead one to conclude that in patients with pure aortic stenosis, echocardiographic evidence of left atrial enlargement as measured by an increased left atrial dimension corrected for body surface area should lead one to suspect severe aortic stenosis.     

Comparison of the efficiency between electrocardiogram and echocardiogram for left ventricular hypertrophy evaluation in patients with hypertension: Insight from the Korean Hypertension Cohort Study

In patients with hypertension, left ventricular hypertrophy (LVH) represents a risk factor for cardiovascular disease and asymptomatic organ damage. Currently, electrocardiography (ECG) and two‐dimensional echocardiography (Echo) are the most widely used methods for LVH evaluation. This study aimed to compare the long‐term outcomes of LVH, as evaluated by ECG and Echo, in patients with hypertension. Patients diagnosed with hypertension as a primary disease between 2006 and 2011 were enrolled in the Korean Hypertension Cohort study. The study finally included 1743 patients who underwent both ECG and Echo. The primary endpoint was defined as the composite of major adverse cardiovascular events (MACEs) or death. Overall, LVH was identified in 747 patients. The patients were categorized into four groups according to the detection of LVH by ECG or Echo: No LVH (n = 996), LVH diagnosed by ECG alone (n = 181), LVH diagnosed by Echo alone (n = 415), LVH diagnosed by both ECG and Echo (n = 151). After adjusting for variables, the incidence of MACEs or death was significantly greater in patients with LVH diagnosed by ECG alone (hazards ratio [HR]: 1.69; 95% confidence interval [CI]: 1.22–2.35; P = .001), LVH diagnosed by Echo alone (HR: 1.54; 95% CI: 1.16–2.05; P = .002), and LVH diagnosed by both ECG and Echo (HR: 1.87; 95% CI: 1.18–2.94; P = .002) than in those with no LVH. Both ECG and Echo are efficient diagnostic tools for LVH and useful for long‐term risk stratification. Additional Echo evaluation for LVH is helpful for predicting long‐term outcomes only in patients without LVH diagnosis by ECG.     

原发性高血压患者左心房增大的相关因素分析

目的观察左心房增大在高血压人群中的发生率,初步探讨左心房增大的独立预测因素及相关机制。方法收集我院门诊或住院的1~2级原发性高血压患者156例,测定血压、血脂、血糖等,计算体重指数,所有患者接受超声心动图及颈动脉超声检查,检测左心房内径(>3.9 cm为左心房增大),将患者分为左心房增大组(36例)及左心房正常组(120例)。计算左心室重量指数,区分有无左心室肥厚。结果23%的患者存在左心房增大,与左心房正常组比较其年龄、病程、体重指数、甘油三酯、空腹血糖、左心室重量指数水平更高,高密度脂蛋白胆固醇水平更低,呈现左心室肥厚、颈动脉内膜增厚或斑块形成、代谢综合征的比例亦显著增高。logistic回归证实,超重(体重指数>25 kg/m2)、左心室肥厚、收缩压≥155 mm Hg(1 mm Hg=0.133 kPa),代谢综合征及颈动脉内膜增厚是预测左心房增大的独立因素。结论左心房增大与超重、左心室肥厚、代谢异常及颈动脉内膜增厚密切相关,可能是高血压病程中出现其他心血管及代谢异常时的适应性反应。