高血压左室重构对心功能及血流动力学影响的研究

目的:研究高血压左室重构对心功能及血流动力学的影响.方法:采用彩色超声心动图对260例原发性高血压与70例正常对照组进行心脏结构和心功能的测定,并依据测定值:左心室重量指数(LVMI)和左室相对室壁厚度(RWT)将高血压病人分为四种构型组:正常构型、向心性重构、向心性肥厚、离心性肥厚.结果:正常构型组:血压(BP)、总外周阻力(TPR)轻度升高,收缩功能正常、舒张功能轻微受损.心脏结构轻度改变.向心性重构组:LVMI在正常范围,但明显高于对照组,RWT超过正常范围,TPR明显高于其它构型组,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.心肌收缩功能尚正常、舒张功能轻度受损.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,E/A和IVRT明显减小和延长,舒张功能明显受损,收缩功能处于亚临床状态.离心性肥厚组:LVMI、LVEDD最大,左心室射血分数(EF)、短轴缩短率(FS)、左室中层短轴缩短率(mFs)最低,左室收缩功能明显下降,舒张功能明显受损.结论:不同左室构型的高血压心功能及血流动力学改变不同,治疗、预后也不同.

THE INFLUENCE OF LEFT VENTRICLE REMODELING ON CARDIAC FUNCTION AND HEMODYNAMIC

Objective:To study the influence of the LV(left ventricle)remodeling caused by hypertension on cardiac function and hemodynamic.Methods:Firstly,by means of colour echocardiography to measure the cardiac structure and the cardiac function of the 260 cases of patients with primary hypertension and the compared group of 70 normal cases;Secondly,according to the LVMI(left ventricular mass index)and RWT(relative wall thickness)we divided the hypertension patients into four groups:NG(normal pattern)group、CCR(concentric remodeling pattern)group、CCH(concentric hypertophy pattern)group、and the ECH(eccentric hypertophy pattern)group.Result:NG group:BP(blood pressure)and TPR(total peripheral resisance)increase slightly,the function of LV systolic is normal but that of LV diastolic is damaged a little.Besides,the cardiac structure changes a little.CCR group:Although the LVMI is in the normal range,it is obviously higher than that of the compared group.The RWT is beyond the normal range,the TPR is higher than that of the other groups clearly,at the mean time,the thickness of the left ventricular wall becomes thicker than those of the compared group.ALL these proved that the systolic function of LV can keep normal but the cardiac diastolic function of LV is damaged slightly.CCH:IVSTD and LVPWTD(the diastolic posterior wall thickness of LV)are thicker than the other two groups.E/A falls down obviously and LVRT is prolonged obviously.The diastolic function of LV goes down significantly,the LV systolic function stays in the subclinical condition.ECH:the LVMI、LVEDD is the bigger than the other two groups,and EF(ejection fraction)、FS(endocardial fractional shortening)and mFS are the lowest,LV diastolic function falls down obviously and the diastolic function of LV is damaged significantly.Conclusion:The treatment and prognosis of different kinds of hypertension with different LV ventricular patterns should be changed according to the different changes of the cardiac function and hemodynamic.