高血压患者左室构型改变与左心舒张功能

目的探讨高血压患者不同左室构型改变与左心舒张功能的关系。方法应用超声心动图和定量组织速度成像技术检测109例原发性高血压患者和26例对照组左心结构及舒张功能各项指标。按照Ganau分类法将高血压患者左室构型分为正常左室构型(A)、向心性重构(B)、向心性肥厚(C)、离心性肥大(D)4种构型,并与对照组(N)比较,对各项指标进行单因素方差分析。结果高血压B、C、D组等容舒张时间(IVRT)延长,后间隔基底段(PS Bas)N:(84.8±23.4),B:(118.9±34.6),C:(133.1±34.6),D:(161.9±62.5)ms,P<0.05];等容舒张期峰值速度(VIR)B、C组和A组的多数节段高于对照组;对照组16.3%节段出现等容舒张期正向波,83.7%为负向波,高血压组64%节段出现等容舒张期正向波,36%为负向波;快速充盈期心肌沿长轴的峰值速度(Ve)高血压组均低于对照组;B、C两组Ve/Va减低。高血压组左房径均大于对照组,B、C、D组逐渐增大。二尖瓣口血流频谱B、C两组VE/VA<1,而在D组VE/VA>1。结论不同左心室构型高血压患者的左心舒张功能均有减低。应用QTVI能够检出二尖瓣血流频谱VE/VA正常的舒张功能异常,并能检测出等容舒张期局部心肌的异常活动,较频谱多普勒更加敏感。

Correlation Between Left Ventricular Diastolic Function and Patterns of Geometric Change in Patients with Essential Hypertension

ObjectiveTo study the correlation between the patterns of geometric remodeling and diastolic function of left ventricle in essential hypertension(EH) patients.MethodsOne hundred and nine EH patients and 26 normal subjects underwent two-dimensional echocardiogram and quantitative tissue velocity imaging(QTVI).According to the Ganau's classification of left ventricular geometry,hypertensive patients were classified into four groups: normal geometry(A),concentric remodeling(B),concentric hypertrophy(C),eccentric hypertrophy(D).ResultsThe isovolumetric relaxation time(IVRT) was prolonged in groups B,C and D.Isovolumetric relaxation peak velocity(VIR) were greater in groups B and C and the some segments in group A than that in control group;Ve/Va was decreased in groups B and C.LA diameter in all hypertensive patients were larger than normal subjects.The flow spectrum analysis of mitral valve: V_E/V_A<1 in groups B and C while the ratio was inverted in group D.ConclusionThe left diastolic function was impaired in EH patients regardless of various types of ventricular geometry.QTVI found abnormal diastolic function in patients even with the normal value of VE/VA.Furthermore,QTVI was able to demonstrate localized ventricular movement and seems more sensitive than the Doppler spectrum analysis.