原发性高血压患者左心房扩大及其影响因素

目的　分析 12 0例原发性高血压患者左心房大小及其影响因素。方法　原发性高血压患者 12 0例 ,男 5 9例 ,女 6 1例 ,年龄 33～ 78岁。全部患者分为两组 ,年龄≥ 6 0岁为老年组 (6 0例 ) ,年龄 <6 0岁为非老年组 (6 0例 )。每组根据心脏超声分为左心室肥厚和无左心室肥厚两个亚组。左心房内径大于 4cm为左心房扩大 ,面积 长度法左心室重量指数男性 >89g m2 ,女性 >77g m2 为左心室肥厚。结果　非老年组 4 3%、老年组 73%合并左心室肥厚 ;非老年组 14例 (2 3% )、老年组 2 2例 (37% )合并左心房扩大 ;37%患者左心房扩大和左心室肥厚同时并存 ,2 0 %患者仅有左心房扩大 ;两组左心房扩大者共 36例 ,其中老年组合并左心室肥厚占 5 0 % (18 36 ) ,非老年组合并左心室肥厚占 2 2 % (8 36 ) ;多因素分析提示超重、血压水平与左心房扩大无显著相关性 ,年龄和左心室重量指数同左心房扩大显著相关。结论　年龄与左心室肥厚是原发性高血压左心房扩大的重要影响因素。     

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。     

老年原发性高血压患者血压晨峰与左心室肥厚的关系

目的探讨老年原发性高血压患者血压晨峰与左心室肥厚的关系。方法选择老年原发性高血压患者80例,根据24 h动态血压监测分为2组:血压晨峰值≥55 mm Hg(1 mm Hg=0.133 kPa)为晨峰组,血压晨峰值<55mm Hg为非晨峰组,每组40例,均常规行超声心动图检查,计算左心室重量指数(LVMI)。结果晨峰组24h、昼间、夜间收缩压及血压晨峰均明显高于非晨峰组(P<0.05),晨峰组LVMI明显高于非晨峰组;左心室肥厚比例明显高于非晨峰组(P<0.05)。结论老年原发性高血压患者血压晨峰与左心室肥厚密切相关。     

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。     

老年高血压患者左心室重构的超声心动图评价

长期的血流动力学负荷是导致老年高血压患者左室重构发生的诱发因素之一〔1〕。大量研究已经证实,高血压引发的左心室重构(LVR)常会诱发一系列心脑血管事件,临床应引起高度重视,并根据患者左心室的不同重构类型给予对症治疗〔2〕。本研究旨在通过超声心动图观察老年高血压患者不同类型的左心室重构特点,运用超声心动图分析心脏的结构和心功能特点,为临床对症治疗老年高血压患者提供参考。     

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。     

原发性高血压患者ST-T向量与左心室舒张功能关系的研究

目的　探讨立体心电图 ST-T向量与左心室舒张功能的关系 ,并与超声心动图对左心室舒张功能 (L VDF)比较评价二者的相关性和敏感性。方法　应用 M型、脉冲多普勒超声心动图对 12 7例原发性高血压患者测定左心房内径 (LAD)、左心室质量指数(LVMI)、EF斜率、射血分数、二尖瓣口血流频谱 A峰 ,E峰 ,A/E比值 ,同时用立体心电图仪对 12 7例原发性高血压患者及 3 0例正常对照组 ST-T向量。结果　原发性高血压左心室肥大 (LVH)组较非左心室肥大 (NL VH)组 A/E比值显著增大。原发性高血压LVH和 NLVH组与对照组比较 ST-T向量各指标均有差异 ;A/E比值与立体心电图 ST-T向量判定 LVDF障碍显著有关联 ,且ST-T向量较 UCG更敏感 ;多元线性回归示 A/E比值与 ST-T向量积分 ,心率 ,年龄 ,危险度分层相关。结论　立体心电图 ST-T向量及其积分与 A/E比值相关良好 ,且可能比后者更为敏感     

高血压左心室肥厚的简易心电图电压标准

目的　寻找心电图 (ECG)诊断左心室肥厚 (LVH)的较好电压标准。方法　以高血压患者为研究对象 ,将目前ECG诊断LVH的各种电压标准与超声心动图左心室心肌重量 (LVM )及左心室心肌重量指数 (LVMI)进行统计分析比较。结果　一项新的电压指标 ,即胸导联最大QRS电压 (简称Vmax)与超声心动图LVMI相关最为密切 (r =0 5 45 ,P <0 0 0 1)。结论　Vmax有希望成为ECG诊断LVH的有效实用的新指标     

心肌最大弹性膜量在原发性高血压左室收缩功能评价中的应用

目的研究用最大弹性膜量(Emax)评价原发性高血压(EH)左室重构的生物力学特性及其临床意义。方法研究对象为96例EH患者(EH组)和30例健康人(正常对照组)。应用超声心动图测定左室收缩及舒张末期内径、左室收缩末期容量、重量指数(LVMI)和相对室壁厚度(RWT)、射血分数(EF)、短轴缩短率(FS)。根据LVMI和RWT将EH患者分为左室正常构型亚组、向心性重构亚组、向心性肥厚亚组、离心性肥厚亚组。应用上述各测值计算最大弹性膜量(Emax)。结果①EF、FS正常对照组分别为(62.74±1.04)%、(34.13±0.78)%,高血压正常构型亚组为(62.24±1.31)%、(33.71±1.96)%,向心性重构亚组为(64.29±1.26)%、(34.96±0.93)%,向心性肥厚亚组为(63.44±1.29)%、(34.69±0.97)%,离心性肥厚亚组为(60.13±2.08)%、(32.68±1.45)%;以EF、FS表示的心脏收缩功能在正常对照组与EH各亚组间、EH各亚组间差异无统计学意义(P>0.05)。②Emax正常对照组为(0.209±0.0014)mmHg/ml,高血压正常构型亚组为(0.520±0.0075)mmHg/ml,向心性重构亚组为(0.697±0.0084)mmHg/ml,向心性肥厚亚组为(0.827±0.0155)mmHg/ml,离心性肥厚亚组为(0.771±0.0129)mmHg/ml。Emax在EH组呈现增高的趋势;在正常对照组与EH各亚组间差异有统计学意义(P<0.01);EH各亚组间Emax差异亦具统计学意义(P<0.01)。结论应用超声心动图无创测定心功能力学参数Emax对EH左室重构心肌生物力学特性的评价具有特殊的诊断价值。     

培哚普利治疗高血压患者左室舒张功能的疗效

目的:观察培哚普利对原发性高血压(EH)患者左心室舒张功能的影响。方法:采用自身对照开放试验方法,观察50例EH患者培哚普利治疗6月后,左心室舒张内径(LVDd)、舒张期室间隔厚度(IVST)、舒张末期左心室后壁厚度(LVPWT)、左心室重量指数(LVMI)、二尖瓣口E峰、A峰、A/E比值的变化。结果:50例EH患者治疗6个月后,IVST、LVPWT、LVMI明显下降(P<0.05),A峰、A/E比值亦明显下降(P<0.05)。结论:培哚普利在降压的同时,不但能逆转左心室肥厚,并且能有效改善左心室舒张功能。     

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3 ± 12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e′ velocity, a′ velocity, and E/e′ ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P = 0.003), interventricular septum (P = 0.001), LV posterior wall thickness (P = 0.001) and E/e′ ratio (P ˂ 0.001), but a decrease in e′ velocity (P = 0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11–1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.     

Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension

To evaluate the value of modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy (LVH) for patients with essential hypertension. A total of 381 patients with essential hypertension diagnosed in our hospital were selected. Using the left ventricle (LV) geometric patterns classified by the American Society of Echocardiography (ASE), we examined the distribution of the modified Cornell criteria of Ravl + S_D (the deepest S wave in 12‐lead ECG) in different geometric patterns and analyzed the correlation of modified Cornell criteria with changes in the LV geometric patterns using multiple linear regression analysis. The distribution of modified Cornell criteria, Sokolow‐Lyon criteria (RV5/V6 + SV1), and Cornell criteria (Ravl + SV3) in gender‐specific hypertensive geometric patterns were significantly different (P ≤ .01 for all). The voltage of Ravl + S_D in male patients showed an increase trend in the normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups, and this increase trend was significantly in the unadjusted model and the adjusted model. The voltages of Ravl + SV3 and RV5/V6 + SV1 of male patients in CR, CH and RH groups showed a gradual increase trend, but the increase trend in CR group has no statistical significance compared to that in NG group (P ≥ .05). The voltages of Ravl + S_D, RV5/V6 + SV1, and Ravl + SV3 in female patients in CR, CH and EH groups showed a trend of increase after decrease in the adjusted model. In conclusion, the modified Cornell criteria could dynamically reflect left ventricular hypertensive geometry of male patients.     

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。     

内源性类洋地黄物质对高血压病患者左室舒张功能的影响

测定 2 0例正常人和 2 0例高血压病患者的心尖搏动图指数、血清内源性类洋地黄物质 （EDL S）浓度、红细胞膜 Na+ - K+ - ATP酶 （钠泵 ）活性及红细胞内钾、钠、钙总量。结果显示 ,与正常人比较 ,高血压病患者的房缩波与E- O垂直高度比值 （A/E- O）明显增高 ,等容舒张期 （IRT）明显延长 ,血清 EDL S浓度明显升高 ,红细胞膜钠泵活性下降 ,红细胞内钠、钙含量升高、钾含量下降 ,且血清 EDL S浓度与 A/E- O,IRT呈显著正相关。提示 EDL S可能参与高血压病患者左室舒张功能异常的形成 ,其机制可能与 EDL S抑制心肌细胞膜钠泵活性并导致细胞内 Ca2 +含量升高有关     

老年原发性高血压并心房颤动患者左心房病变分析

【】目的 探讨老年原发性高血压合并房颤患者左心房病变情况,为临床治疗此类患者提供指导。方法 回顾分析老年原发性高血压患者合并房颤者110例,其中阵发性房颤者42例,非阵发性房颤68例。收集心脏超声断面图收缩期左心房前后径(LAD)和左室射血分数(LVEF)等资料,并进行比较。结果 非阵发性房颤组LAD显著增大(P<0．05),房颤的发生与维持与血压、年龄及LAD相关。结论 老年原发性高血压患者合并房颤者可出现显著的左心房扩大,年龄、高血压、左心房扩大均为心房颤动的危险因素。     

超声心动图评价高龄高血压患者左心室收缩与舒张功能

目的探讨超声心动图各指标评估高龄老年高血压患者左心室不同构型的收缩与舒张功能的临床价值。方法将高龄老年原发性高血压患者153例,按Ganau法分为4组:正常构型组(47例)、向心性重构型组(35例)、向心性肥厚型组(33例)和离心性肥厚型组(38例);另选无心肺疾病的患者65例为正常对照组。超声心动图测量舒张末期室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室内径(LVEDD)、二尖瓣血流频谱图舒张早期与晚期血流峰值比(E/A)、LVEF及Tei指数。结果正常对照组及以上4组E/A均<1;离心性肥厚型组LVEF明显降低(P<0.05),正常构型组、向心性重构型组、向心性肥厚型组比较无显著差异;以上4组Tei指数与正常对照组比较差异有显著性意义(P<0.05),但4组间比较无显著差异,Tei指数和E/A无相关性,Tei指数和LVEF呈负相关(r为-0.594,P<0.001)。结论Tei指数较E/A及LVEF更能全面评价高龄老年高血压患者心脏的收缩和舒张功能。     

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.     

斑点追踪成像技术评价原发性高血压患者左室心肌分层应变的研究

目的:探讨采用斑点追踪成像( STI)技术测定左室心内膜层和心外膜层心肌收缩期峰值应变评价原发性高血压(EH)左室不同构型患者左室收缩功能的价值.方法:入选EH患者56例(EH组),其中非左室肥厚30例(A亚组),左室肥厚26例(B亚组);健康志愿者53例(对照组).应用STI技术获取所有对象左室长轴及短轴各切面的心内、外膜层心肌收缩期纵向、径向峰值应变及左室心内、外膜层心肌的整体纵向和径向峰值应变值.结果:B亚组患者左室心内、外膜层心肌收缩期纵向峰值应变显著低于对照组(心内膜层:P＜0.01;心外膜层:P＜0.05),EH组二尖瓣水平短轴径向峰值应变显著高于对照组(P＜0.05).结论:EH患者径向应变的增高代偿了纵向应变的减低,STI可评价EH不同构型患者左室整体和局部收缩功能从而为早期发现心肌病变提供了无创性的新方法.