老年高血压患者不同左室构型对心功能和颈动脉结构的影响

目的观察不同左室构型的老年高血压患者心功能和颈动脉结构的变化。方法78例老年高血压患者根据超声左室构型分为四组:正常构型组(n=34)、向心性重构组(n=18)、向心性肥厚组(n=11)和离心性肥厚组(n=15)。测定与比较各组24 h动态血压、左室功能、颈动脉内径、血流参数和斑块发生率。结果向心性肥厚组24 h平均收缩压高于正常构型及向心性重构组(P<0.01)。离心性肥厚组左室射血分数低于正常构型组(P<0.05),Tei指数高于正常构型组(P<0.05)。向心性肥厚和离心性肥厚组颈总动脉内-中膜厚度(IMT)均高于正常构型组(P<0.05),且向心性肥厚组颈动脉分叉处IMT高于其他三组(P<0.01)。向心性肥厚组斑块检出率(54.55%)较高,但组间比较无显著差异。结论在老年高血压人群中,不同左室构型左心功能和颈动脉结构变化不同,离心性肥厚者心功能受损最明显,心室肥厚者颈动脉重构发生率较高。

Effects of left ventricular geometric patterns on cardiac function and carotid artery structure in elderly patients with essential hypertension

Objective To observe the changes of cardiac function and carotid artery structure in elderly hypertensive patients with different left ventricular geometric patterns. Methods Seventy-eight elderly patients with essential hypertension were divided into 4 groups according to left ventricular geometric patterns by ultrasonography: normal ventricular geometry group(n=34),concentric remodeling group(n=18),concentric hypertrophy group(n=11)and eccentric hypertrophy group(n=15).The 24-h ambulatory blood pressure,left ventricular function,carotid artery intima-media thickness(IMT),hemodynamic parameters and incidence of plaque were measured and compared among groups.Results Patients in concentric hypertrophy group had higher 24-h average systolic blood pressure in comparison with those in normal ventricular geometry group and concentric remodeling group(P<0.01).Patients in eccentric hypertrophy group had lower ejection function(P<0.05) and higher Tei index(P<0.05) in comparison with those in normal ventricular geometry group.Patients in concentric and eccentric hypertrophy groups had increased IMT in common carotid artery in comparison with those in normal ventricular geometry group(P<0.05),and those in concentric hypertrophy group had increased IMT in branch of carotid artery compared with the other groups(P<0.01).Besides,plaque detection rate was relatively higher in concentric hypertrophy group(54.55%),while no significant difference was observed amony groups.Conclusion Left ventricular geometric patterns lead to different changes of cardiac function and carotid artery structure in elderly patients with essential hypertension.Cardiac dysfunction was more frequent in eccentric hypertrophy,while left ventricular hypertrophy may contribute more to carotid artery remodeling.