超声心动图评价主动脉瓣狭窄合并高血压病患者左室重构及左心功能

Echocardiographic evaluation of the left ventricular remodeling patterns distribution and function in aortic stenosis with hypertension

目的了解症状性主动脉瓣狭窄患者中高血压病的发病率,运用超声心动图对主动脉瓣狭窄合并高血压病患者的左室重构类型及左心功能进行测定,评价高血压病对主动脉瓣狭窄的症状发生及临床情况是否产生额外的影响。方法 193例有症状的主动脉瓣狭窄患者(男性113,女性80,平均年龄68±9岁)接受了超声心动图检查。根据左室心肌质量指数以及相对室壁厚度,将左室重构分为四种类型:正常构形、向心性重构、向心性肥厚和离心性肥厚。结果 62例(32％)症状性主动脉瓣狭窄患者同时合并高血压病,而131例(68％)患者血压正常。两组之间LV重构类型的分布比例相似,均以向心性肥厚为主。反映左室收缩、舒张以及左室整体功能的指标均无显著差别。但是,与血压正常的患者相比,主动脉瓣狭窄同时合并高血压组具有较大的主动脉瓣口面积和较低的搏出功损耗。结论在有症状的主动脉瓣狭窄患者中,合并高血压病并非少见,它对左室重构类型及左室功能并不产生额外的影响。合并高血压病的主动脉瓣狭窄患者在病变相对早期的阶段即可产生症状,对这类患者高血压的治疗和随访应更加积极。

Objective To determine the prevalence of aortic stenosis（AS） with hypertension in a large series of patients with symptomatic AS, to assess Left ventricular remodeling patterns distribution in AS patients with and without hypertension, and to evaluate the additional effect of systemic hypertension on the clinical status and symptoms in patients with AS. Methods Echocardiography was performed in 193 patients with symptomatic AS （113 males, 80 females, mean age 68±9 years）. The prevalence of systemic hypertension was assessed. According to the left ventricular mass index and relative wall thickness four different left ventricular remodeling patterns were identified： normal pattern, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Results A history of hypertension was present in 62 patients （32%） with symptomatic AS and other 131 cases （68%） had normal blood pressure. No significant differences were found between hypertensives and normotensive patients as far as age, male/females ratio, mean NYHA class, distribution of symptoms, left ventricular systolic and diastolic function, and remodeling patterns. In hypertensive patients, however, symptoms were present with larger aortic valve areas and lower stroke work loss. Conclustions Systemic hypertension is not rare in patients with symptomatic AS. Symptoms develop with larger valve area and lower stroke work loss in hypertensive patients. It could suggest that in AS with hypertension, hypertension should be treated more aggressively to delay the occurrence of symptoms, and these patients should be followed up more closely.