左室收缩末期生物力学变化与舒张性心衰发病机制的相关性

目的 分析原发性高血压患者左心室收缩末期最大心肌劲度（maxEav）、最大弹性模量（Emax）与二尖瓣环舒张早期与心房收缩期峰值速度比（E/A）的相关性。方法 选取298例原发性高血压患者作为研究对象，计算患者的左室质量指数（left ventricular mass index，LVMI）和相对室壁厚度（relative wall thickness，RWT)，并基于LVMI和RWT指标分成4组，分别为正常结构（left ventricular normal，LVN）、向心性重构（left ventricular concentric remodeling，LVCR）、离心性肥厚（left ventricular eccentric hypertrophy，LVEH）、向心性肥厚（left ventricular concentric hypertrophy，LVCH）。另选取115名健康人入对照组。对入选者进行超声心动图诊断，分析maxEav、Emax与E/A之间的相关性。结果 LVCR、LVEH、LVCH 3组研究对象maxEav、Emax与E/A均呈现负相关。LVCR组、LVCH组与对照组间E/A比较，差异具有统计学意义。与对照组相比，高血压各组maxEav、Emax均减小，差异具有统计学意义。结论 maxEav、Emax是判断左室舒张功能更为敏感且简便易得的指标。分析高血压左室重构合并舒张功能异常患者maxEav、Emax变化，探索舒张性心衰的发病机制，可以为今后预防及治疗舒张性心衰提供理论依据。

Correlation between Biomechanical Changes at the End of Left Ventricular Systole and Pathogenesis of Diastolic Heart Failure

Objective To analyze the correlation of the maximum myocardial stiffness (maxEav), maximum modulus of elasticity (Emax) with the E/A ratio of mltral annulus at the end of left ventricular systole for patients with essential hypertension. Methods 298 patients with essential hypertension were selected as research objects. The left ventricular mass index (LVMI) and relative wall thickness (RWT) of the patients were calculated. Based on LVMI and RWT indexes, the patients were divided into left ventricular normal (LVN) group, left ventricular concentric remodeling (LVCR) group, left ventricular eccentric hypertrophy (LVEH) group, left ventricular concentric hypertrophy (LVCH) group, respectively. In addition, 115 healthy subjects were selected into control group. The subjects were diagnosed by echocardiography, so as to analyze the correlation of maxEav, Emax with E/A. Results The maxEav, Emax and E/A in LVCR group, LVEH group and LVCH group were all negatively correlated. The differences of E/A between LVCR group, LVCH group and control group showed statistical significance. Compared with control groups, both the maxEav and Emax in hypertension group decreased, and the difference was statistically significant. Conclusions The maxEav and Emax are more sensitive and easy indexes to judge left ventricular diastolic function. The analysis on maxEav and Emax changes in patients with left ventricular remodeling and diastolic dysfunction in hypertension, as well as the exploration on pathogenesis of diastolic heart failure, can provide the theoretical basis for prevention and treatment of diastolic heart failure in the future.