组织多普勒定量评价高血压与冠心病伴或不伴左室肥厚患者心脏舒缩功能

目的　评价高血压与冠心病伴或不伴左室肥厚患者心脏舒缩功能，以及DTI评价高血压与冠心病左室舒张功能的准确性。方法 对正常人组(n=15例)，高血压组（n=30例，15 例非左心室肥厚（non-LVH）和15例左心室肥厚（LVH）) 及冠心病组（n=33例，15 例非左心室肥厚（non-LVH）和18例左心室肥厚（LVH）)分别测量:① 二尖瓣口舒张早期充盈速度(E) 和舒张晚期充盈速度(A)； ② 二尖瓣环心肌组织等容收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）和舒张晚期峰值速度（Va），以及用猪尾导管直接测量LVEDP。结果　与对照组相比，高血压组和冠心病组Ve/Va、E/A均显著减小（P＜0.05）；冠心病LVH组的Ve/Va、E/A与高血压LVH组的比较无明显差异（P＞0.05），而冠心病non-LVH组的Ve/Va、E/A比高血压non-LVH组的均减小（P＜0.05）。冠心病组的Vs明显低于对照组和高血压组的Vs（P＜0.05），而对照组和高血压组的Vs比较则无明显差异（P＞0.05）。Ve/Va与LVEDP的相关性高于E/A与LVEDP的相关性。结论　高血压和冠心病患者伴或不伴左室肥厚均存在左室舒张功能降低，然而左室收缩功能降低仅见于冠心病患者，DTI是评价左室舒张功能的良好方法。

Quantitative Evaluation of systolic and diastolic Function of Myocardium in Hypertension and coronary artery disease with or without left ventricular hypertrophy by Tissue Doppler Imaging

Objective The aim of this study was to assess left ventricular systolic and diastolic function, using Doppler tissue imaging (DTI), in hypertension or coronary artery disease patients with or without left ventricular hypertrophy, and to evaluate the accuracy of assessing left ventricular diastolic function by DTI.Methods We investigated 15 age-matched healthy subjects, 30 patients with hypertension with (n=15) or without (n=15) left ventricular hypertrophy,and 33 patients suffering from coronary artery disease with (n=15) or without (n=18) left ventricular hypertrophy by DTI. Mitral pulse-wave Doppler E/A ratio, Mitral annular myocardial tissue isovolumic peak systolic velocity (Vs), early diastolic peak velocity (Ve), and peak late diastolic velocity (Va), were obtained. Pigtail catheter was directly used to measure LVEDP.Results Compared with control group, Ve/Va and E/A were significantly reduced significantly in hypertension and coronary artery disease group (P<0.05); There were no significantly differences in Ve/Va and E/A between CAD with LVH and hypertension with LVH. Compared with hypertension with non-LVH group, Ve/Va and E/A were reduced in CAD with non-LVH group (P<0.05). Vs in the CAD group was significantly lower than that in the control group and hypertension group (P<0.05), whereas Vs was not significantly different between the control group and hypertension group (P>0.05). Ve/Va showed better correlation with LVEDP than E/A.Conclusion Left ventricular diastolic function is reduced in hypertension and CAD patients with or without left ventricular hypertrophy, However, lower left ventricular systolic function is only found in patients with CAD. DTI is a good way to evaluate left ventricular diastolic function.