组织多普勒显像评价高血压患者右室舒张功能的临床研究

Evaluation of right ventricular diastolic function in patients with essential hypertension by echocardiography

目的应用组织多普勒评价原发性高血压患者右室舒张功能。方法依据Gannu分类方法将90例原发性高血压分为四组:Ⅰ组为正常左室构型组(30例),Ⅱ组为向心性构型组(18例),Ⅲ组为向心性肥厚组(22例),Ⅳ组为离心性肥厚组(20例)。选取同期健康志愿者50例作为对照组。应用组织多普勒技术测量三尖瓣隔叶及前叶瓣环处的舒张早期运动速度(Em)、舒张晚期运动速度(Am)及Em/Am比值,同时记录舒张期三尖瓣口的血流频谱,测量心室充盈早期峰值E峰和心房收缩期峰值A峰,计算E/A比值,并对两种检测方法和各组测值进行比较。结果原发性高血压各组三尖瓣瓣环运动速度频谱Em/Am均<1;Ⅱ、Ⅲ、Ⅳ组等容舒张期时间(IVRT)较Ⅰ组及对照组明显延长(P<0.01),且Ⅱ、Ⅲ、Ⅳ组间呈递增趋势;高血压Ⅲ组、Ⅳ组三尖瓣血流频谱均E/A<1,而Ⅰ组、Ⅱ组及正常组三尖瓣血流频谱均E/A>1。结论与脉冲多普勒相比,组织多普勒显像可早期发现原发性高血压导致的右室舒张功能受损,且不同的左室构型右室舒张功能减退的程度有所差别。

Objective To assess fight ventricular diastolic function in patients with hypertension by echocardiography. Methods 90 patients withessential hypertension were enrolled which were divided into four groups according to Gannu categories . At the same time , 50 sex and age matched healthy subjects were enlisted as control group. PW data and TDI data were acquired from tricuspid and its＇ annulus respectively on apical four chamber view. Results Em/Am 〈 1 was observed in all of patients with hypertension . Isovolumic relaxation time（IVRT）were delayed in groups Ⅱ、Ⅲ、Ⅳ compared with group Ⅰ and control group .At the same time, there was a tendency to become longer among the fomaer three groups. E/A 〉 1 was observed in control group as well as group Ⅰ and Ⅱ while E/ A〈 1 in group Ⅲ and group Ⅳ. Conclusions Tissue Doppler imaging is more sensitive than Pulse Doppler in evaluating decreased right ventricular diastolic function in patients with essential hypertension, and the decrement of the function was different in degree based on variant left ventricular configurations.