摘要
目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。
Objective： To investigate the clinical significance of assessing left ventricular （ LV ） diastolic function by pulsed tissue Doppler imaging （TDI） echocardiography in newly diagnosed essential hypertensive subjects （EH） without LV hypertrophy.
Methods： The average diastolic mitml annular velocity （Emav, Amav and Emav/Amav ratio） from four separate sites （basal septus,lateral, anterior, and inferior LV wall） were detected by TDI echocardiography in 66 subjects with newly diagnosed uncomplicated EH and 50 normotensives. The relationship between the measurements and the indices of conventional echocardiography was analyzed.
Results： Compared with normotensives hypertensives exhibited greater LV mass index （LVMI） and LV relative wall thickness （RWT） （P 〈 0. 01, P 〈 0. 001, respectively）, and lower Emav and Emav/Amav values （ P 〈 0. 001 for both ）, but Amav had no obvious difference between the two groups （ P = 0. 26）. The rato of mitral flow velocity to early diastolic average velocity of the mitral annulus （E/Emav） in hypertensives was higher than in normotensives. In group of hypertensives, a univariate analysis revealed that TDl-derived Emav/Amav ratio was negatively correlated with IVRT and EDT（ r = - 0. 306 ,P 〈 0. 05 ;r = - 0. 392,P 〈0. 01 ） ,but not correlated with E/Emav. A multivariate analysis showed that the significant determinants of Emav/Amav ratio were age and RWT （P 〈0. 001 ,P 〈 0. 05 ,respectively）, while the conventional Doppler-derived E/A ratio was significantly asso- ciated only with age （P 〈0. 01 ）.
Conclusions： LV diastolic function exhibited decreased relaxation and no obvious changing compliance in the early stages of EH subjects without LV hypertrophy, thus left ventricular filling pressure might be elevated. TDI-detected LV diastolic dysfunction was accompanied by the evolvement of earlier LV concentric remodeling.
出处
《中国循环杂志》
CSCD
北大核心
2007年第5期362-365,共4页
Chinese Circulation Journal
关键词
高血压
舒张功能异常
组织多普勒
Hypertension
Diastolic dysfunction
Tissue Doppler
