高血压病左心室重构的超声评价

The structural and functional characteristics of concentric remodeling and concentric hypertrophy of left ventricle in essential hypertension

目的探讨高血压病左心室向心性重构与向心性肥厚的超声学特征。方法超声检测116例高血压病患者的左心结构、左心室舒张与收缩功能及背向散射积分,分析向心性重构型与向心性肥厚型上述超声检测参数的主要异同。结果高血压病左心室向心性重构型和向心性肥厚型患者左心室舒张末期室间隔厚度(IVSTd)、舒张末期左心室后壁厚度(LVPWTd)、舒张晚期心房收缩时肺静脉反流持续时间(ARD)较正常构型高(P＜0.05),左心室射血分数(EF)斜率、E/A比值、左心室中层缩短率(mFs)较正常构型低(P＜0.05)；舒张末期左心室内径(LVEDd)、舒张末期左心房容积(LAEVd)、左心室重量指数(LVMI)、左心室等容舒张期时间(IVRT)、收缩末期室壁应力(ESWS)、Tei指数及室间隔(IVS)、左心室后壁(LVPW)的背向散射积分(IBS)周期性变化幅度的跨壁梯度(TGCVIB)等,在向心性肥厚型均高于向心性重构型(P＜0.05)；而E峰、IVS的IBS周期性变化幅度(CVIB)等指标,则为向心性重构型高于向心性肥厚型(P＜0.05)。结论上述超声参数是反映高血压向心性重构与向心性肥厚结构和功能变化特征的敏感指标。

Objective To study the ultrasonographic characteristics of the left ventricular geometries with concentric remodeling and concentric hypertrophy in essential hypertension. Methods A series of ultrasonic parameters were used to examine the left ventricular structure, diastolic and systolic functions, and ultrasonic integrated backscatter （IB%） in 116 patients with essential hypertension, and the differences and similarities between concentric remodeling and concentric hypertrophy were analyzed. Results In both geometries of concentric remodeling and concentric hypertrophy, interventricular septal end-diastolic thickness （IVSTd）, left ventricular posterior wall end-diastolic thickness （LVPWTd） and atrium relaxation duration （ARD） were increased （P 〈0.05）, while ejection fraction （EF） slope, E/A ratio and mid fraction shortening （mFs） of left ventricle were decreased （P 〈 0.05 ）, compared with patients with normal geometry. The pattern of concentric hypertrophy had a higher evaluation than that of concentric remodeling in left ventricular end-diastolic dimension （ LVEDd）, left atrium end-diastolic volume （ LAEVd）, left ventricular mass index （LVMI）, isovolumic relaxation time （IVRT） ,end-systolic wall stress （ESWS）, Tei index, interventricular septal （IVS） of cyclic variation of integrated backscatter （CVIB） and left ventricular posterior wall （LVPW） of transmural gradient of cyclic variation of integrated backscatter （TGCVIB） （P 〈 0.05 ）, while the pattern of concentric remodeling had a higher evaluation than the counterpart of hypertrophy in peak E and IVS of CVIB （P 〈 0.05）. Conclusions As sensitive indexes, these ultrasonic parameters reflect the shared and different characteristics of concentric remodeling and concentric hypertrophy in essential hypertension and therefore have clinical significance.