超声心动图对老年舒张性心力衰竭患者心脏结构和功能改变的评价

Assessment of cardiac structure and function with echocardiography in elderly DHF patients

目的通过超声心动图检查探讨老年舒张性心力衰竭(diastolic heart failure,DHF)患者心脏结构及舒张和收缩功能的变化情况。方法对129例老年DHF患者(DHF组)和79例年龄匹配的健康老年人(对照组)进行超声心动图检查,测量左心室容积、左心房容积、左心室质量,获取二尖瓣血流、右上肺静脉血流频谱,用组织多普勒测量二尖瓣环心室长轴方向的收缩期心肌峰值运动速度(Sm)、舒张早期心肌峰值运动速度(Em)等值,并进行分析。结果与对照组比较,DHF组患者左心室舒张末容积指数轻度增大,左心室质量指数明显增大,左心房容积指数明显增大,Sm和Em均明显下降,差异均有统计学意义(P<0.01)。相关分析显示,Sm与左心室质量指数独立相关(β=-0.018,P<0.01),左心房容积指数与老年DHF患者舒张功能不全程度独立相关(β=0.002,P<0.01)。结论老年DHF患者总体表现为显著的向心性增厚,左心房的大小与舒张功能受损程度相关;收缩与舒张功能的损害,可能共同参与老年DHF发生和发展的过程。

Objective To investigate the changes of cardiac structure and systolic and diastolic function with echocardiography in the elderly diastolic heart failure（DHF） patients. Methods A cross-sectional echocardiography study comparing elderly DHF patients （n = 129） and control healthy senile subjects （n = 79） was performed. LV mass,LV volume and LVEF were obtained and trans-mitral E velocity, A velocity, DT were measured. The peak regional myocardial sustained systolic（Sin） and early diastolic（Era） velocities of mitral annulus were obtained by tissue Doppler imaging. Results Compared with the controls, the left atrial volume was significantly larger （P 〈 0.01） ,the left ventricular volume was increased slightly （P〈0. 01） and LVMI was significantly larger in DHF patients than in controls （P〈0. 01）. The index of LVEDV/LVM showed a feature of concentric left ventricular hypertrophy in the elderly DHF patients. Sm in 4 sites of mitral annulus and the mean Sm in elderly DHF decreased significantly compared with controls （P 〈 0.01）,so did Em （P 〈 0.01）. There was a significant correlation between Sm and LVMI,and LAVI was significantly correlated to the degree of diastolic dysfunction. Conclusions The elderly DHF patients present a feature of significant concentric left ventricular hypertrophy and overt left atrial enlargement. Systolic dysfunction was evident in the elderly DHF patients diagnosed by LVEF〉50% besides the diastolic dysfunction,indicating the coexistence of systolic and diastolic dysfunction in the pathophysiologic process of DHF.