超声心动图评价高血压患者右室重构与右室功能的研究

Study on right ventricular remodeling and right ventricular function in hypertensive patients by echocardiography

目的探讨超声心动图评价高血压右室重构及右室功能的临床价值。方法高血压患者62例,按左室重量指数分为无左室肥厚组(A组,33例)和左室肥厚组(B组,29例)。对照组为28例健康者。二维超声测量右室前壁厚度(RVAWTd)、右室舒张期内径(RVEDd);三尖瓣反流法估测肺动脉收缩压(PASP);脉冲组织多普勒成像技术(PW- TDI)测量三尖瓣环心肌运动收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)和S峰速度时间积分(Sm-VTI),分别采用PW-TDI与脉冲多普勒测量右室Tei指数。结果与对照组比较,A、B组Em和Em/Am下降,Am和Tei指数升高(均P<0.01);与A组比较,B组Em、Em/Am、Sm下降,Am、Tei指数、RVAWTd及PASP升高(P<0.05,P<0.01)。两种方法所测Tei指数存在相关性:对照组(r=0.78,P<0.01),高血压组(r=0.72,P<0.01)。结论高血压患者右室功能减低,在左室肥厚同时可发生右室重构并进一步影响右室功能,TDI测定右室Tei指数能简便有效评价高血压右室功能。

Objective To investigate the clinical value of echocariogrphy in assessment of right ventricular remodeling and fight ventricular fimetion in hypertensive patients. Methods Sixty - two patients with hypertension and 28 normal subjects underwent transthoracic echocardiography. All patients were divided into group A （non- left ventricular hypertrophy patients, 33 cases） and group B （left ventricular hypertrophy patients, 29 cases ） according to left ventricular mass index. Right ventricular anterior wall diastolic thickness （RVAWTd） , right ventricular end- diastolic dimension（RVEDd） and pulmonary artery systolic pressures （PASP） were measured by 2D echocardiography and pulsed wave Doppler of tricuspid flow regurgitation, respectively. Systolic peak velocities （Sm）, S peak velocity time integral （Sm- VTI）, early - and late - diastolic peak velocities （Em and Am） , the Em/Am ratio of tricuspid annular motion were detected by pulsed wave tissue Doppler imaging（PW - TDI）. Tei index of right ventricule was measured by PW- TDI and pulsed wave Doppler of tricuspid flow （PWD）. respectively, Results Compared with the control group, group A, group B showed increased Am, Tei index and decreased Em, Em/Am ratio （all P 〈 0.01）. Compared with group A, group B showed decreased Em, Em/Am ratio, Sm and increased Am, Tei index, RVAWTd and PASP （ P 〈 0.05 or P 〈 0.01 ）. Tei index measured by PW - TDI and PWD correlated with each other both in hypertensive patiens （ r = 0.72, P 〈 0.01 ） and control group （ r = 0.78, P 〈 0.01 ）, Conclusion Right ventricular function decreases in hypertensive patients, right ventricular remodeling maybe exist with left ventricular hypertrophy and further effect the right ventricular function. Tei index measured by TDI is a reliable and simple method in assessment of right ventricular function in hypertensive patients.