Tei指数评价原发性高血压病患者左室舒张功能

目的探讨Tei指数评价原发性高血压病左室不同构型的舒张功能的临床价值。方法原发性高血压病患者115例,以Ganau分类法分为4组:正常构型组36例,向心性重构组36例,向心性肥厚组31例,离心性肥厚组12例;另选择体检健康者35例为对照组。应用M型超声测量左室的舒张末期内径(LVEDD)、后壁厚度(LVPWT)、室间隔厚度(IVST);改良Simpson法测量左室射血分数(LVEF);脉冲多普勒测量二尖瓣舒张早期血流峰值流速(E)、舒张晚期血流峰值流速(A)、E峰减速时间(EDT),计算E/A;测量肺静脉血流频谱收缩期肺静脉血流峰值(PVS)、舒张早期血流峰值(PVD),计算PVS/PVD,组织多普勒测量左室Tei指数。结果高血压病组左室舒张功能均减低。正常构型组、向心性重构组、向心性肥厚组E/A1,EDT延长;离心性肥厚组E/A1,其EDT较正常构型组、向心性重构组、向心性肥厚组缩短,收缩功能减低,LVEF与对照组比较差异有统计学意义(P0.05);对照组、高血压病各组Tei指数依次增加,组间差异均有统计学意义(均P0.05);左室Tei指数与LVEF、A峰呈负相关,与IVST、LVPWT、LVEDD、RWT、LVMI、E峰、E/A呈正相关;Tei指数ROC曲线下面积为0.986,以Tei指数为0.425鉴别有无左室舒张功能不全的敏感性为97%,特异性为83%。结论 Tei指数与原发性高血压病患者左室不同构型具有良好的相关性,原发性高血压病早期Tei指数即发生改变,随舒张功能不全的加重而增高;Tei指数可作为评价鉴别二尖瓣血流"假性正常化"的参考指标之一。

Assessment of left ventricular diastolic function in patients with essential hypertension using Tei index

Objective To explore the clinical value of Tei index in assessment of left ventricular diastolic function in patients with essential hypertension and left ventri cular different geometric patterns. Methods One hundred and fifteen patients with essential hypertension were enrolled. According to Ganau categories,these patients were divided into four groups as follows：36 patients with normal left ventricle , 36 patients with concentric remodeling , 31 patients with concentric hypertrophy and 12 patients with eccentric hypertrophy. Thiry-five healthy subjects as control group were included. Interventricular septum end-diastole thickness （IVST）,left ventricular posterior wall thickness （LVPWT）,and left ventricular end-diastolic dimension （LVEDD） were measured using M-mode ultrasonography. Left ventricular ejection fraction （LVEF） were measured using the Simpson formula. The mitral and pulmonary venous flow were measured using pulsed Doppler echocardiogram including peak flow velocity of early diastole （E）,peak flow velocity of atrial contraction （A）,E/A ratio,the deceleration time of E（EDT）,pulmonary venous flow velocity of systole （PVS）,pulmonary venous flow velocity of diastole （PVD）,and PVS/PVD ratio. Tei index was measured using tissue Doppler imaging. Results Left ventricular diastolic function in hypertension were lower than those of the normal. The E/A ratios of normal left ventricle,concentric remodeling,concentric hypertrophy were 1. In the normal left ventricle,concentric remodeling,concentric hypertrophy group,the EDT were higher than eccentric hypertrophy. LVEF in eccentric hypertrophy was decreased,and has significant difference compared with that in control group（P〈0.05）. Tei-index of the hypertension group were increased than that of the normal. There was significant difference between concentric hypertrophy and normal left ventricle,as well as between eccentric hypertrophy and normal left ventricle, concentric remodeling,concentric hypertrophy （all P〈0.05）. Left ventricular Tei index were negatively correlated with LVEF and A,and positively correlated with IVST,LVPWT,LVEDD,R WT,LVMI,E and E/A. The area under the receiver operating characteristic （ROC） curve was 0.986 for the Tei index. Using that cutpoint of Tei index=0.425,diastolic function insufficiency was identified with a sensitivity of 97% and a specificity of 83%. Conclusion Tei index were positive correlation with left ventricular different geometric patterns in patients with essential hypertension. Left ventricular diastolic function was changed in the early stage of essential hypertension. The worse diastolic function was,the higher Tei index was. Tei index can be used as one of reference indexes for distinguishing pseudonormal lization of mitral flow velocity curve pattern.