原发性高血压患者心脏组织多普勒与血流多普勒图像改变

目的应用组织多普勒检测三尖瓣环处心肌的运动特点，并与三尖瓣口血流频谱对比评价原发性高血压患者右室舒张功能。方法依据Gannu分类方法将124例原发性高血压患者分组：正常左室构型组32例为Ⅰ组，向心性构型组30例为Ⅱ组，向心性肥厚组32例为Ⅲ组，离心性肥厚组30例为Ⅳ组，另选取健康查体者35例为对照组。应用脉冲多普勒（PW）测量三尖瓣口血流速度参数，心室充盈早期峰值E峰和心房收缩期峰值A峰，计算E／A比值；组织多普勒技术测量三尖瓣隔叶及前叶瓣环处的舒张早期运动速度（Em）、舒张晚期运动速度（Am），计算Em／Am值。并对两种检测方法和各组测值进行比较。结果原发性高血压Ⅲ组、Ⅳ组三尖瓣血流频谱A值增大，E／A〈1，与对照组及高血压I组、Ⅱ组比较，差异有统计学意义（P〈0．05）。原发性高血压各组Em／Am均〈1；不同组间Em／Am比较，差异有统计学意义（P〈0．05）。结论组织多普勒显像比脉冲多普勒更早、更敏感地发现原发性高血压导致的右室舒张功能受损，且随着左心室室构的不同，右室舒张功能减退的程度有所差别。

Images change of pulsed Doppler and tissue Doppler in evaluation of right ventricular diastolic function in patients with essential hypertension

Objective To assess right ventricular diastolic function in patients with essential hypertension using tricuspid valve flow spectrum and tricuspid annulars motion dectected by echocardiography. Methods According to Ganau′s categories, 124 patients with essential hypertension were enrolled,which were divided into four groups:normal left ventricular configurational group (group Ⅰ, n =32 ), centripetal reconstruction group (group Ⅱ, n =30), centripetal hypertrophy group ( group Ⅲ, n =32), eccentric hypertrophy group ( group Ⅳ, n =30 ). Control group consisted of 35 normal subjects pulsed wave Doppler(PW) data and tissue Doppler imaging(TDI) data were acquired from tricuspid and its' annulus respectively on apical four chamber view. Results EPA ＞ 1 was observed in control group as well as group Ⅰ and Ⅱ ,while E/A ＜ 1 in group Ⅲ and group Ⅳ ,there were significant differences between them. Em/Am ＜ 1 was observed in all of patients with hypertension,there were significant differences among them( P ＜ 0.05 ) .Conclusion Tissue Doppler imaging was more sensitive than pulse Doppler in evaluating decreased right ventricular diastolic function in patients with essential hypertension, and the decrement of the function was different in degree based on variant left ventricular configurations.