多普勒组织成像技术对高血压患者左室舒张功能临床评价

Assessment of left ventricular diastolic function in patients with hypertension by Doppler tissue imaging

目的采用多普勒组织成像技术(DTI)检测二尖瓣环舒张期运动速度,评价高血压患者左室舒张功能的临床价值。方法将82例原发性高血压患者分为两组:心肌不增厚组(non-LVH)35例,心肌增厚组(LVH)47例;另设对照组(健康人)101例。①在二尖瓣环后间隔和左侧壁位点,用DTI法分别检测高血压患者及健康人舒张早期e1、e2,舒张晚期a1、a2峰值,同时计算e/a比值。②在二尖瓣口用血流脉冲多普勒法(PWD)测舒张期血流E峰、A峰、E/A比值。③取右上肺静脉(PV)频谱,测收缩期血流速度(PVS)、舒张期血流速度(PVD)、S/D比值及心房收缩期逆向血流速度(PvaV)及时间(PvaT),并进行对照分析。结果①高血压患者non-LVH组、LVH组二尖瓣环DTI参数e1、e2、e1/a1、e2/a2均明显低于对照组(P<0.01)。②non-LVH、LVH组二尖瓣口血流参数E、E/A明显低于对照组(P<0.05,P<0.01),而A明显高于对照组(P<0.05)。non-LVH组、LVH组DTI与PWD参数相关性分析表明:e1/a1、e2/a2与E/A比值呈正相关,相关性良好(r=0.65,r=0.76;r=0.56,r=0.64;均P<0.01)。③non-LVH组、LVH组PV参数S/D比值明显高于正常组(P<0.05,P<0.01)。LVH组PvaV、PvaT,明显大于正常组及non-LVH组(均P<0.01)。结论DTI二尖瓣环运动速度能客观反映左室舒张功能受损。DTI结合肺静脉血流参数,可提高综合分析高血压病左室舒张功能的准确性。

Objective To explore the value of Doppler tissue imaging （DTI） in assessing the left ventricular diastolic function by detecting mitral annular velocity in diastole in patients with hypertension. Methods Eighty-two patients with hypertension and 101 health subjects were studied. The patients were divided into two groups ：35 cases with left ventricular hypertrophy （LVH） and 47 cases without left ventricular hypertrophy （ non- LVH）. Mitral annular velocity in early and late diastole at posterior septum（ e1, a1 ） and lateral wall （e2, a2 ） were measured by DTI in health subjects and patients. Mitral inflow velocity E, A and E/A ratio were detected. The systolic velocity （PVS） , diastolic velocity （PVD） , atrial systolic retrograde velocity （PvaV） and time （PvaT） in right superior pulmonary vein were also measured. Results （ 1 ） The e1, e2, e1/a1, e2/a2 of hypertensive patients in non-LVH and LVH were lower than those of health subjects （P 〈 0.01 ）. （2） E and E/A in non-LVH and LVH were lower than those of health subjects （ P 〈 0.05, P 〈 0.01 , separately）, but A was higher than that of health subjects（P 〈 0.05 ）, e1/a1 and e2/a2 were positively correlated with E/A in non-LVH and LVH（r=0. 65,r=0.76, r=0. 56,r=0. 6d,P〈0.01）. （3） S/D in non-LVH and LVH were higher than that of health subjects （P 〈0.05 ,P 〈 0.01, separately）, PvaV and PvaT in LVH and non-LVH were higher than those of non-LVH and health subjects （ all P 〈 0.01 ）. Conclusion Measurement of mitral annular velocities by Doppler tissue imaging （DTI） can evaluate objectively left ventricular diastolic function and enhance the accuracy of diagnosis by integrating pulmonary vein parameter in patients with hypertension.