多普勒超声心动图估价肺动脉高压对左心室功能的影响

Left ventricular function in pulmonary arterial hypertension:assessed by Doppler echocardiography

目的:探讨肺动脉高压对左心室结构和功能的影响。方法:将58例患者分为肺动脉高压组(n=29)和无肺动脉高压的对照组(n=29)。肺动脉高压组依据肺动脉收缩压进一步分为3个亚组:A组9例,肺动脉收缩压≥40mmHg(1mmHg=0.133kPa)但≤70mmHg;B组11例,肺动脉收缩压>70mmHg但<100mmHg;C组9例,肺动脉收缩压≥100mmHg。采用多普勒超声心动图测量相关参数。结果:①与对照组相比,肺动脉高压组左心室舒张末期内径明显缩小、室间隔厚度显著增厚、舒张早期流速峰值(E峰)与舒张晚期流速峰值(A峰)比值和左心室射血分数下降(均P<0.05)。②在肺动脉高压亚组中,各组间仅E峰值存在显著性差异,且随肺动脉收缩压升高,E峰值下降(r=-0.892,P<0.01)。结论:肺动脉高压不仅引起左心室结构改变,且导致舒张充盈障碍,并随肺动脉收缩压升高而加重。

Objective To assess the effect of pulmonary arterial hypertension （PAH） on left ventricular （LV）structure and function. Methods Twenty nine patients with PAH（PAH group） and 29 subjects without PAH （control group） were enrolled. The patients in PAH group were further divided into 3 subgroups based on puhnonary arterial systolic pressure （PASP）： PASP between 40 mm Hg （1 mm Hg=0.133 kPa）and 70 mm Hg, 9 patients （group A）, between 70 mm Hg and 100 mm Hg,11 patients （group B）,and higher than 100 mm Hg, 9 patients（group C）. Correlated parameters were measured by Doppler echocardiography. Results ① LV end-diastolic dimension and interventricular septal thickness increased significantly and ratio of peak early （E） to late （A） diastolic filling velocity and LV ejection fraction decreased significantly in PAH group （P〈0.05）. ② Peak early filling velocity differed significantly between the 3 PAH subgroups, PASP was inversely related to peak early velocity （r=-0.892, P〈0.01）. Conclusions This study indicates that PAH not only may cause LV structural change, but also may cause impairment of diastolic filling. The impairment of diastolic filling increases with the increase of PASP.