高血压患者左室不同构型的特点

OBJECTIVE: To observe the clinical characteristics of different patterns of the left ventricule in hypertensive patients. METHODS: Echocardiography was used in 228 essential hyventricule of heart in hypertensive patients and 60 healthy individuals. RESULTS: In the hypertensive group, the rate of normal left ventricle, concentric remodeling, concentric hypertrophy and eccentric hypertrophy were 21.9%, 36.4%, 32.9% and 8.8%, respectively. The aortic root dimension and left atrial dimension were higher in the hypertensive group than those in the normal group (P < 0.05), especially for concentric hypertrophy and eccentric hypertrophy. Cardiac index and stroke volume index in eccentric hypertrophy were higher than those in the normal group and concentric remodeling (P < 0.05). Ejection fraction and fractional shortening in concentric remodeling were the highest and ejection fraction in eccentric hypertrophy was the lowest among all patterns (P < 0.05). E/A rate was lower in the hypertensive group than in the normal group (P < 0.05), especially for concentric hypertrophy and eccentric hypertrophy. The total peripheral resistance was the highest in concentric remodeling and the lowest in eccentric hypertrophy (P < 0.05). CONCLUSION: Different patterns in the left ventricle have their own characteristics and patients should be treated differently according to the patterns.     

高血压病患者左室重构的研究

评价高血压病患者左室重构和心功能的变化，应用超声心动图对１４６例原发性高血压病人的左心结构和功能进行研究，并与７２例正常作对照结果显示：左室正常构型占５３％，向心性重构占１５％，向心性肥厚占１３％，离心性肥厚占１９％向心性肥厚组左室舒张功能受损最重，离心性肥厚组收缩功能较其它组降低向心性肥厚和离心性肥厚组的年龄和病程无显著差异，但均大于左室正常构型和向心性重构组向心性肥厚和离心性肥厚组的血压均显著高于其它构型组，离心性肥厚组ＴＰＲ无增高，其余三种构型组均明显升高向心性肥厚和离心性肥厚组ＬＶＥＳＳ均显著高于左室正常构型和向心性重构组结果表明，高血压病人左室几何形状的改变与其血液动力学异常和心脏的负荷改变相适应     

高血压病患者不同左室构型与胰岛素抵抗的相关性

目的 探讨高血压患者胰岛素抵抗对左室构型的影响.方法 对高血压组164例进行常规心脏超声、空腹葡萄糖(FBG)、空腹胰岛素(FIN)、血脂检查.采用胰岛素敏感指数(HOMA-IR)作为评价胰岛素抵抗指标,按Gnanu分类法将高血压组划分为正常构型、向心性重构组、向心性肥厚组和离心性肥厚组.采用组间比较、相关性分析等统计学方法进行评价.结果 高血压患者按左室重量指数(LVMI)分组,两组间空腹胰岛素及胰岛素抵抗差异无统计学意义(P>0.05);但按相对室壁厚度(RWT)分组,空腹胰岛素及胰岛素抵抗差异具有统计学意义(P<0.05).并且向心性重构组和向心性肥厚组明显高于正常构型组(P＜0.05),而离心性肥厚组与正常构型组比较差异无统计学意义(P>0.05).逐步回归分析显示LVMI与体重指数、收缩压和舒张压呈正相关(P<0.05-P<0.01),RWT与HOMA-IR呈负相关(P<0.05).结论 胰岛素抵抗可能是高血压患者合并左室肥厚的重要影响因素之一,改善胰岛素抵抗有利于高血压患者左室肥厚的防治.     

高血压不同左室构型患者QT间期离散度的研究

目的：研究高血压不同左室型患者QT间期离散的变化。方法：应用超声心动图计算左室重量指数（LVMI）和相对室壁厚度（RWT），按LVMI和RWT将左分为4种构型，对117例例原发性高血压病人的QT间期离散度进行研究，并以45例临床人作为对照组。结果：高血压组除正常构型外，其余QT间期离散度均大于对照组，而向心性肥厚和离心性肥厚组大于向心性重构组，向心性重构组大于正常构型组。QT间期离散度与LVMI正相关。结论：高血压不同左室构型患者QT间期离散度不同，随着LVMI增加QT间期离散度加大。     

肥胖高血压患者左室构型特点及危险因素的Logistic回归分析

目的 探讨中心性肥胖合并高血压患者左室构型的特点及影响因素,为防治肥胖相关性高血压的心脏损害提供思路。方法 本研究采用横断面流行病学调查方法,共纳入2015年5月~2016年2月我院心内科门诊及住院的227例中心性肥胖合并高血压病患者。采集患者一般资料、炎症因子、早期肾脏损害指标、尿酸、B型钠尿肽（BNP）、心脏超声等。根据心脏超声特点将患者分为正常构型、向心性重构、离心性肥厚、向心性肥厚四组,采用非条件Logistic回归分析影响左室构型紊乱发生的危险因素。结果 227例患者中,正常构型58例（25.55%）,向心性重构99例（43.61%）,向心性肥厚44例（19.38%）,离心性肥厚26例（11.45%）;其中左室构型紊乱者高达74.45%,以向心性重构为主。经非条件Logistic回归分析,超敏C反应蛋白（hsCRP）水平升高（OR=1.591,95%CI=1.185~2.073）、血压分级升高（OR=1.611,95%CI=1.008~2.575）、BNP升高（OR=1.408,95%CI=1.064~1.863）、年龄增长（OR=1.524,95%CI=1.054~2.203）增加了中心性肥胖合并高血压患者发生左室构型紊乱的风险。结论 ①中心性肥胖合并高血压患者左室构型紊乱者高达74.45%,以向心性重构为主。②中心性肥胖合并高血压患者,随着hsCRP、年龄、BNP和血压等级升高,发生左室构型紊乱的风险也增加。     

老年高血压患者左室构型和胰岛素抵抗的关系

目的了解老年高血压患者左室构型和胰岛素抵抗的关系.方法测定58例未经正规治疗的老年原发性高血压患者空腹血糖、胰岛素,计算胰岛素抵抗指数(IR)和胰岛素敏感指数(ISI),同时利用心脏多普勒技术将左室构型分为4型,观察IR和构型的关系.结果与对照组G0比较,老年EH各组空腹血清胰岛素(FIN)、IR大于G0(P＜0.05),ISI小于G0(P＜0.05).EH各组间FIN、IR、ISI差异无显著性(P＞0.05).RWT与IR呈正相关(r=0.34,P＜0.05),与ISI呈负相关(r=-0.265,P＜0.05).LVMI与IR、ISI无显著相关(P＞0.05).结论胰岛素抵抗及高胰岛素血症存在与老年EH患者的各种左室构型中,老年EH患者胰岛素敏感性降低与RWT增加密切相关.     

原发性高血压左室构型的研究

目的:研究高血压患者左室构型的改变.方法:采用彩色超声心动图对226例原发性高血压与51例正常对照组进行心脏结构的测定.结果:正常构型组:左室内径、室壁厚度、LVMI、RWT保持正常,左房内径(LAD)、升主动脉内径(Aos)较对照组增宽.向心性重构组:LVMI虽在正常范围,但明显高于对照组,RWT超过正常范围,左室壁厚度开始增厚并高于对照组,左室舒张末径(LVEDD)小于对照组.向心性肥厚组:左室舒张末期室间隔厚度(IVSTD),左室舒张末期后壁厚度(LVWPTD)最厚.离心性肥厚组:IVSTD、LVWPTD增厚虽有所减轻,但LVMI、LVEDD最大.结论:正常构型组、向心性重构组所占比例较大,能有效控制其构型的发展可从根本上减少心血管事件的发生率和死亡率.     

原发性高血压患者左室构型与颈动脉粥样硬化的关系

目的:探讨原发性高血压(EH)患者左室构型(LVG)与颈动脉粥样硬化(CAS)之间的关系。方法:原发性高血压106例,按Ganau分类法分为4型:正常构型(Ⅰ组)28例、向心性重构(Ⅱ组)32例、向心性肥厚(Ⅲ组)26例及离心性肥厚(Ⅳ组)20例;正常对照组30例。采用美国超声协会推荐的方法测量室间隔(I VS)、左室后壁厚度(LVPW)、左室舒张末内径(LVDd),计算左室重量指数(LVMI)。同时超声测量颈总动脉内中膜厚度(I MT)、观察有无颈动脉斑块形成,从而判断有无颈动脉粥样硬化。结果:颈总动脉的I MT在Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组呈递增趋势,均高于正常对照组,且Ⅲ组、Ⅳ组显著高于Ⅰ组、Ⅱ组及正常对照组(P<0.05);Ⅱ组与Ⅰ组及正常对照组间差异亦有统计学意义(P<0.05);原发性高血压各组CAS的检出率明显高于正常对照组,变化与颈总动脉I MT基本一致;同时高血压病患者LVMI与颈动脉粥样硬化形成间有显著正相关(r=0.55,P<0.05)。结论:颈动脉粥样硬化的发生与原发性高血压左室构型密切相关。     

二维M型和多普勒超声心动图对高血压不同左室构型心功能的研究

目的：进一步探讨高血压病左室构型与心功能及临床关系。方法：应用二维、M型和多普勒超声心动图对原发性高血压患者135例进行检测，分别测量舒张期室间隔(IVSd)和左室后壁(LVPWd)厚度、左室内径(LVd)。根据由此计算出的左室重量指数(LVMI)和室壁相对厚度(RWT)，将高血压患者左室分为四种构型，并测量EF、FS、左房内径(LAd)和升主动脉内径(AAO)、二尖瓣口舒张期E峰、A峰速度、舒张早期减速时间(DT)、等容舒张期时间(IVRT)等，并进行分析。结果：高血压患者早期有左房扩大，E／A值下降，向心性肥厚的室间隔和左室后壁增厚量明显，E／A值和IVRT、DT明显减小和延长，舒张功能下降明显。离心性肥厚虽然室壁增厚有所减轻，但左心重量指数(LVMI)最大，左室扩大明显，EF、FS最低，收缩和舒张心功能均下降明显。结论：高血压病左室构型与临床关系紧密。超声心动图对左室构型的区分，对高血压病的诊断和治疗有着重要价值。     

高血压患者左室构型异常与心电图QTd、QTcd的关系

目的:观察高血压患者的左室构型与QT离散度(QTd)、校正的QT离散度(QTcd)的关系。方法:分析164例高血压患者左室构型及QTd、QTcd资料。结果:向心性肥厚组、离心性肥厚组的QTd与QTcd明显高于正常构型组与向心性重构组(P<0.01),离心性肥厚组的QTd与QTcd比向心性肥厚组明显增高(P<0.01)。结论:高血压患者左室构型异常的程度与QTd与QTcd增高的程度相一致,随着靶器官受累程度加重,QTd与QTcd异常越明显。     

Comparison of Arrhythmias among Different Left Ventricular Geometric Patterns in Essential Hypertension

It was proved epidemiologically and practicallythatthe leftventricularremodeling in essentialhyper-tension was an important independent risk factor forcardiovascular evidentand was closely correlated witharrhythmias and sudden death[1] . One reason wasthat left ventricular remodeling could result in ar-rhythmias.The relation between hypertension andarrhythmias gradually drawn the attention of the re-searchers in recent years[2 ] . At present arrhythmiasin essential hypertension was regarded to…     

氯沙坦对原发性高血压患者左心室重塑的影响

目的 :探讨氯沙坦在治疗原发性高血压中对左心室重塑的预防和逆转的作用。 方法 :12 0例原发性高血压患者随机分为氯沙坦组和对照组 (波依定组 ) ,入院时行超声心动图测定室间隔厚度 (IVSd)、左心室后壁厚度(LVPW ) ,并计算左心室重量指数 (LVMI)。治疗 6个月后复查上述指标。 结果 :(1)对照组治疗后LVPW和IVSd有变薄的趋势 ,但差异无统计学意义 ,治疗 6个月后LVMI下降且具有统计学意义 (P <0 .0 5 ) ;(2 )氯沙坦组治疗 6个月后LVPW、IVSd、LVMI均有改善 ,且具有统计学意义 (P <0 .0 5 ) ;(3)两组间降压幅度差异无统计学意义。 结论 :降低血压可抑制和逆转左心室重塑 ,但血管紧张素Ⅱ受体拮抗剂还具有降压外的消退和预防左心室肥厚及改善左心室舒张功能的作用 ,其抑制和逆转左心室重塑 ,保护心脏功能作用优于钙离子拮抗剂。     

Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

Background Pulmonary hypertension （PH） is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle （LV）？ The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging （Wl） technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups：mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity （Tvl）,the peak systolic longitudinal velocity （Vsl）,the peak diastolic longitudinal velocity （Vel）,the peak systolic longitudinal strain （SI）,and strain rate （SRI） in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference （P ＞0.05）.With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant （P ＜0.01）,and the differences between other groups were statistically significant （P ＜0.01）.In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant （P ＜0.01）.Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable.     

启心饮对高血压左室肥厚模型大鼠左室重构的干预作用

目的:观察启心饮对高血压左室肥厚大鼠模型血压、心肌舒缩功能及左室重构的影响。方法:将60只SD雄鼠随机分为假手术组、模型组、西药(雅施达)组、丹参组、启心饮高剂量组、启心饮低剂量组,每组10只。除假手术组外,均进行高血压左室肥厚动物模型制备。各组从造模前一日开始,每日灌胃相应药物或蒸馏水,连续8周。分别于造模前、造模后4周、造模后8周测量血压。干预8周后,心超测定室间隔厚度(LAD)、左室后壁厚度(LVST)、射血分数(EF)等,计算相对室壁厚度(RWT);取心脏计算左室质量指数(LVMI);取心肌组织进行HE染色及病理形态学观察。结果:干预8周后,启心饮高、低剂量组收缩压较模型组明显降低(P0.01);其中高剂量组作用较低剂量组作用明显(P0.01)。干预8周后,模型组RWT较假手术组明显增高(P0.01);与模型组比较,启心饮高、低剂量组RWT均显著降低(P0.01);各组EF差异无统计学意义(P0.05)。反映心肌肥厚程度的LVMI,模型组较假手术组显著升高(P0.01);启心饮高剂量组LVMI较模型组显著降低(P0.01)。心肌组织的病理学观察显示西药组及启心饮高剂量组的心肌形态均得到明显改善。结论:启心饮能明显降低高血压左室肥厚大鼠的收缩压、改善心肌舒缩功能,具有逆转左室重构的作用。     

Left ventricle geometry remolding after heart transplantation: A two-dimensional ultrasound study

The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass （LVM）, and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation （HT）. The purpose of this study was to dy- namically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end dias- tole were measured and the relative wall thickness （RWT）, left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index （LVMI） and RWT. The HT patients were divided into three groups ac- cording to the time length after surgery： A （3 months postoperatively）, B （6 months postoperatively） and C （12 months postoperatively）. We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients （16%） in group A had concentric remodeling. Nine patients （34.62%） in group B had re- construction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients （62.5%） had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hyper- trophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hy- pertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.     

高血压患者左心室构型与动态脉压的关系

目的: 探讨高血压病患者左心室不同构型与动态脉压的关系。方法: 根据超声心动图测定的左心室重量指数和左室壁相对厚度,对130例高血压病患者进行左心室构型分类;应用24 h动态血压监测并分析24 h,日间和夜间平均脉压。通过多元逐步回归分析,甄选出对动态脉压有独立影响的因素,校正影响因素后,再比较左心室不同构型组间的24 h,日间及夜间平均脉压的差异。40例正常人作为对照组。结果: 年龄和24 h平均动脉压是对24 h,日间和夜间平均脉压有独立影响的两个最重要的因素,校正影响因素后,向心性重构组、向心性肥厚组和离心性肥厚组的24 h,日间平均脉压均较对照组及左心室正常构型组明显增大（P<0.05）,而左室重构组间的24 h,日间和夜间平均脉压的差异无统计学意义。结论: 高血压病患者左心室重构与动态脉压有密切关系,脉压增大是高血压病患者左心室重构的重要危险因素。     

Real-time three-dimensional echocardiographic assessment of left ventricular remodeling index in patients with hypertensive heart disease and coronary artery disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.     

轻度妊娠高血压左心室重构的危险性

目的 探讨轻度妊娠高血压初孕妇左心室重构与预后的关系。方法 200例妊娠（28～31）周的轻度妊娠高血压初孕妇,由产科医师随访至正常分娩或胎）L／孕妇出现异常情况（先兆子痫、在34周前分娩、胎盘早剥、与妊娠有关的疾病、胎儿窘迫、低体重新生儿、入新生儿监护室）,由Logistic回归法分析不良妊娠结果与左心室构型的关系。结果 138例（69．0％）妊娠平稳,62例（31．0％）出现不良妊娠结果,向心性重构孕妇和向心性肥大孕妇的不良妊娠结果构成比较高（分别为64．7％和63．2％,χ^2=29．5,v=3,P=0．000）;Logistic回归分析显示向心性重构（OR5．5,95％CI1．1-28．4,P=0．042）和向心性肥大（OR6．0,95％CI1．1～32．6,P=0．038）是不良妊娠结果的独立预报因子。结论 轻度妊娠高血压左心室向心性重构和左心室向心性肥大与不良妊娠结果有关。