摘要
目的应用二维超声心动图观察不同左心室构型原发性高血压患者心尖形态及动力学变化。方法将101例原发性高血压患者分为左心室正常构型、向心性重构、向心性肥厚和离心性肥厚4组,以38例正常血压健康体检者为对照组。应用二维超声分析左心室心尖顶角(θ_(Ap))及其收缩期变化率(Δθ_(Ap))、心尖短轴缩短率(FSAp)、心尖和左心室流出道射血峰值速度(VAp、VLVOT)及其比值(V_(Ap)/V_(LVOT))。结果与对照组比较,左心室射血分数(LVEF)仅在高血压左心室离心性肥厚组降低,其余组增高(均P<0.05),而二尖瓣环纵向收缩速度在各构型组均降低,以离心性肥厚组为著(均P<0.05)。心尖顶角随着左心室重构进展呈先减小后扩大趋势,其中在向心性肥厚组最小、离心性肥厚组最大[(95.2±8.2)°比(81.6±7.1)°比(78.3±6.2)°比(98.0±9.5)°,P<0.05]。心尖顶角收缩期变化率及心尖短轴缩短率也呈现先增强后降低趋势,且正常构型、向心性重构、向心性肥厚组较对照组增大[Δθ_(Ap):(15.6±5.4)%比(24.1±10.5)%比(30.8±10.3)%比(26.5±9.8)%比(14.3±10.0)%;FSAp:(37.1±5.6)%比(44.5±9.4)%比(47.3±10.1)%比(43.9±10.0)%比(33.5±13.5)%,P<0.05]。在高血压患者中,Δθ_(Ap)与LVEF值中度相关(r=0.48,P<0.05),而在对照组,Δθ_(Ap)与LVEF值相关性无统计学意义。结论原发性高血压患者左心室向心性重构阶段心尖收缩呈代偿性增强;心尖顶角及其变化率与心尖射血速度可作为评价心尖形态学和动力学的指标。
Objective To investigate apical morphology and dynamics of left ventricle(LV)in essential hypertension patients with different LV geometry by two-dimensional echocardiography.Methods A total of 101 hypertensive patients were divided into four groups:normal geometry(NG),concentric remodeling(CR),concentric hypertrophy(CH)and eccentric hypertrophy(EH).Thirty-eight healthy subjects served as normal control group(NC).The apical angle(θ_(Ap)),apical angle changing rate(Δθ_(Ap)),apical fractional shortening(FSAp),ejection velocity of apex(VAp)and LV outflow tract(VLVOT)as well as their ratio(VAp/VLVOT)were analyzed with two-dimensional echocardiography.Results LV ejection fraction(LVEF)increased in the NG,CR,CH groups and decreased in EH group(P<0.05).Mean systolic velocity of mitral annulus(Sa)decreased in all hypertensive patients,especially in the EH group(P<0.05).θ_(Ap)showed a trend of first increasing and then decreasing,which was the smallest in CH group and the largest in EH group[(95.2±8.2)°vs(81.6±7.1)°vs(78.3±6.2)°vs(98.0±9.5)°,P<0.05].Δθ_(Ap)and FSAp also increased firstly and then decreased,which were higher in NG,CR,CH groups than NC group[Δθ_(Ap):(15.6±5.4)%vs(24.1±10.5)%vs(30.8±10.3)%vs(26.5±9.8)%vs(14.3±10.0)%;FSAp:(37.1±5.6)%vs(44.5±9.4)%vs(47.3±10.1)%vs(43.9±10.0)%vs(33.5±13.5)%,P<0.05].Δθ_(Ap)was moderately correlated with LVEF in hypertension patients(r=0.48,P<0.05),but not correlated in NC group.Conclusions The hypertensive apical contraction increases in compensation at the stage of left ventricular concentric remodeling.θ_(Ap),Δθ_(Ap)and VAp can be used as indexes for the evaluation of apical morphology and dynamics.
作者
苏宏达
阮琴韵
林胜男
鄢磊
黄惠美
侯婉青
黄春燕
SU Hong-da;RUAN Qin-yun;LIN Sheng-nan;YAN Lei;Huang Hui-mei;HOU Wan-qing;HUANG Chun-yan(Ultrasound Imaging Department,The First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2021年第10期953-958,共6页
Chinese Journal of Hypertension
基金
福建省科技计划引导性项目(2017Y0031)
福建省健康科技计划项目青年科研课题(2018-2-18)
福建省教育厅中青年教师科研项目(JAT200131)。
关键词
原发性高血压
心尖重构
动力学
超声心动图
essential hypertension
apical remodeling
dynamics
echocardiography
