四维面积应变评价不同左心室构型高血压患者的左心室功能

目的评价四维应变成像技术面积应变（4D-area strain）检测高血压不同左心室构型患者左心室收缩功能的价值。 方法收集2015年2月至8月浙江省杭州市余杭中医院确诊的原发性高血压患者125例，根据Ganan分类法分为：正常构型组45例（A组）、向心性重构组25例（B组）、向心性肥厚组25例（C组）及离心性肥厚组30例（D组）。另选取本院体检中心40名健康人作为健康对照组（N组）。采用4D-area strain检测各组与健康对照组常规左心室收缩功能指标与整体面积应变（GAS）、节段面积应变（RAS）值，进行相互比较。组间整体面积应变与对应的节段面积应变比较采用多样本均数方差分析，多个均数间的两两比较采用LSD-t检验。 结果（1）常规心功能：A、B、C、D及N组左心室舒张末期容积（EDV）、心搏量（SV）及心输出量（CO）测值比较，差异均无统计学意义（F =0.679、3.829、0.600，P均>0.05），收缩末期容积（ESV）、射血分数（EF）、球形指数（Spl）、舒张末期重量（EDMass）测值比较，差异均有统计学意义（F=3.829、6.596、2.653、2.604，P均<0.05）；D组ESV测值与N、A、B、C组比较，差异有统计学意义（t =2.011、2.244、3.685、2.278，P均<0.05）；B组ESV测值与N组比较，差异有统计学意义（t=2.170，P<0.05）；B组EF测值与N、A、D组比较，差异有统计学意义（t =2.452、3.514、4.949，P均<0.05）；D组EF测值与N、C组比较，差异有统计学意义（t=2.849、3.486，P均<0.05）；D组SpI测值与N、A、B、C组比较，差异有统计学意义（t =2.854、2.941、3.200、2.979，P均<0.05）；C组EDMass测值与N、A组比较，差异有统计学意义（t=2.170、2.087，P均<0.05）；D组EDMass测值与A、B、N组比较，差异有统计学意义（t=2.668、2.081、3.762，P均<0.05）。（2）GAS：A、B、C、D各组与N组GAS测值比较，差异均有统计学意义（t=7.950、7.361、8.959、11.277，P均<0.01），且随左心室重构程度加重差异更为明显；A、B组GAS测值分别与D组比较，差异均有统计学意义（t =3.332、2.102，P均<0.05），A组GAS测值与C组比较，差异有统计学意义（t=3.134，P<0.05）。（3）RAS：D组所有节段与N组比较，差异均有统计学意义（第1~17节段，t分别为2.967、3.793、4.896、4.001、2.375、4.169、4.077、2.137、4.652、4.016、5.230、6.267、5.735、2.143、2.353、5.429、4.128，P均<0.05）；A、B、C 3组与N组比较，基底段的前间隔壁、后间隔壁、前侧壁，中间段的前侧壁，心尖段的前壁、侧壁、心尖帽，差异均有统计学意义（A-N：t=2.667、3.084、3.574、4.771、3.182、4.806、3.567，P均<0.05；B-N：t=2.702、2.868、2.179、3.130、3.302、3.203、3.093，P均<0.05；C-N：t=4.927、5.600、4.276、6.577、6.198、5.190、5.441，P均<0.05）；A、B、C 3组与N组心尖间隔段比较，差异均无统计学意义（t=0.934、1.562、1.879，P均>0.05）。 结论4D-area strain为不同左心室构型高血压患者左心室收缩功能的检测提供一种新方法，尤其是对早期收缩功能的检测更为敏感。

The evaluation of left ventricular function in hypertension patients with different left ventricular configuration by four-demensional imaging area strain

ObjectiveTo evaluate the left ventricular systolic function of different patients with hypertension by Four-demensional imaging area strain (4D-area strain). MethodsTotally 125 hypertension patients and 40 normal subjects (group N) were enrolled. According to Ganan classification, hypertension patients were classified into normal geometry (groups A, n=45), concentric remodeling (group B, n=25), concentric hypertrophy (group C, n=25) and eccentric hypertrophy (group D, n=30). Parameters of left ventricular systolic function, including global area strain (GAS), regional area strain (RAS) and left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), spherical index (Spl), end-diastolic weight (EDMass) were analyzed. ResultsThere was no statistically significant difference among thegroups A, B, C, D, and N in left ventricular EDV, SV and CO (F=0.679, 3.829, 0.600, P>0.05). There were statistically significant differences among ESV, EF, Spl and EDMass (F=3.829, 6.596, 2.653, 6.596, P<0.05). There were statistically significant differences among ESV of group D and that of groups N, A, B and C (t=2.011, 2.244, 3.685 and 2.244, P<0.05). There was statistically significant difference among ESV of group B with that of group N (t=2.170, P<0.05). There were statistically significant differences among EF of group B with that of groups N, A and D (t=2.452, 3.514 and 2.452, P<0.05). There were statistically significant differences among EF of group D with that of groups N and C (t=2.849 and 3.486, P<0.05), There were statistically significant differences among SpI of group D with that of groups N, A, B and C (t=2.854, 2.941, 3.200 and 2.941, P<0.05). There were statistically significant differences among EDMass of group C with that of groups N and A (t=2.170 and 2.087, P<0.05). There were statistically significant differences among EDMass of group D with that of groups A, B and N (t=2.668, 2.081 and 3.762, P<0.05). There were statistically significant differences in GAS among groups A, B, C, D and group N (t=7.950, 7.361, 8.959 and 7.361, P<0.01), and the difference was more apparent with the increasing of left ventricular remodeling. There were statistically significant differences in the comparison of GAS in group D and groups A and B, respectively (t=3.332 and 2.102, P<0.05). There were statistically significant differences in the comparison of GAS in group A and group C (t=3.134, P<0.05). There were statistically significant differences in the comparison of group D and N in the segment of 1-17, respectively (t=2.967, 3.793, 4.896, 4.001, 2.375, 4.169, 4.077, 2.137, 4.652, 4.016, 5.230, 6.267, 5.735, 2.143, 2.353, 5.429 and 2.353, P<0.05). There were statistically significant differences in the comparison of groups A, B, C and group N, including basal anteroseptal, basal posteroseptal, basal anterolateral, mid anterolateral, apical anterior, apical lateral and apex (A-N: t=2.667, 3.084, 3.574, 4.771, 3.182, 4.806, 3.567, all P<0.05; B-N: t=2.702, 2.868, 2.179, 3.130, 3.302, 3.203, 3.093, all P<0.05; C-N: t=4.927, 5.600, 4.276, 6.577, 6.198, 5.190, 5.441, all P<0.05). There was no statistically significant difference in apical septal among the groups A, B, C and groups N (t=0.934, 1.562 and 0.934, P>0.05). Conclusions4D-area strain is a convenient and noninvasive method for evaluation of left ventricular systolic function in patients with different patterns of hypertension. Especially, it′s more sensitive in the early detection of left ventricular systolic function.