超声心动图评价原发性高血压病不同左心室构型舒张功能的变化

目的探讨超声心动图多项指标评价原发性高血压病不同左室构型患者左心室舒张功能的改变。方法选择正常对照组29例，原发性高血压患者116例，按照Ganau分型法，即根据左室质量指数（LVMI）和相对室壁厚度（Rwr）将其分为4组。常规脉冲多普勒（PWD）测量二尖瓣口舒张早期峰值流速（VE）、舒张晚期峰值流速（VA）及两者比值E／A。测量右上肺静脉收缩期峰值流速（VS）、舒张期峰值流速（VD）、心房收缩期负向峰值流速（AR），计算S／D。PWD测量等容舒张期时间（IVRT）。组织多普勒技术（TDI）测量二尖瓣后瓣环处舒张早期与舒张晚期峰值速度及其比值（Ea／Aa）。结果与正常对照组比较，CR、CH及EH组的E／A比值降低，差异有统计学意义（P〈0．05）；CR组的S／D比值增大（P〈0．01）；高血压各组的AR及IVRT明显增大及延长（P〈0．001）；CR组、CH组、EH组的Ea／Aa比值明显降低（P〈0．01）；TDI对舒张功能减低的检出率（81％）高于PWD检出率（71．6％）j差异有统计学意义（P〈0．01）。结论原发性高血压患者无论左心室构型如何，左心室舒张功能均已发生改变，以向心性肥厚组及离心型肥厚组明显。多指标联合应用能较全面地反映左心室舒张功能变化，且TDI较PWD更能敏感、简便及准确地判断高血压患者左心室舒张功能异常。

Assessment of left ventricular diastolic function with different left ventricular geometric patterns in essential hypertensive patients by echocardiography

Objective To evaluate left ventricular(LV) diastolic function with different left ventricular geometric patterns in patients with hypertension by muti-echocardiography.Methods The study included 29 healthy participants as the control group and 116 patients with primary hypertension.The patients were divided into four groups based on left ventricular mass index(LVMI) and relative wall thickness(RWT).E/A ratio( E/A) at mitral orifice and VS/VD ratio(S/D)were measured by pulse wave Doppler(PWD),also,isovolumetric relaxation time(IVRT) was measured.Ea/Aa ratio(Ea/Aa) at posterior mitralis annulus were detected by Tissue Doppler Imaging(TDI).Results Compared with the control subjects,E/A ratio was decreased significantly in C R 、CH、EH group(P ＜ 0.05) ;AR and IVRT were significantly different between hypertensive groups and normal group(P ＜0.001),S/D ratio in CR group was increased( P ＜ 0.01) ;Compared with the control subjects,Ea/Aa ratio was decreased significantly in CR、 CH and EH group(P ＜ 0.01).The detection rate of Ea/Aa (81%)was higher than the detection rate of E/A(71.6%)about left ventricular diastolic function.Conclusion Left ventricular diastole function in essential hypertension changed whatever in left ventricular geometric patterns,especially in CH and EH group.Compared with PWD,TDI is valuable for estimating left ventricular diastole functions with high sensitivity.