组织多普勒对高血压左心室舒张功能的评估

The evaluation of left ventricular diastolic function by tissue Doppler echocardiography in essential hypertension

目的 探讨组织多普勒评价高血压患者左心室舒张功能方面的优越性.方法 将高血压患者分为无左室肥厚亚组（160例）和左室肥厚亚组（40例）,选160例健康体检者为对照组,测定舒张早、晚期二尖瓣血流速度（E、A）峰值及左室侧壁二尖瓣环舒张早期运动速度（Em）.结果 左室肥厚亚组Em、E/Em变化较无左室肥厚亚组差异有统计学意义[（7.7±2.6）cm/s比（9.9 ±2.8）cm/s;9.6 ±3.6比7.4±2.4,P＜0.05],而A、E/A则差异无统计学意义[（0.90 ±0.22）cm/s比（0.87 ±0.17）cm/s;0.80 ±0.34比0.88 ±0.28,P＞0.05].结论 组织多普勒指标Em、E/Em反映左室舒张功能的变化更敏感.

Objective To evaluate Left ventricular（LV） diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography （cPWD） and Doppler tissue imaging （DTI） and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup （n = 160） and LVH subgroup （n =40） based on left ventricular mass index （LVMI） with one hundred and sixty health subjects as control group. The mitral valve flow pattern （MVFP） was obtained.Early diastolic （E） and late velocities （A） were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity （Em） and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD （higher E and lower E/A ratio） and DTI （lower Em and higher E/Em ratio） compared with healthy subjects [E：（0. 88 ±0. 18）cm/s vs （0. 76 ±0. 19） cm/s;E/A ratio：0. 86 ±0. 28 vs 1.02 ±0. 38;Em： （9. 4 ±2. 8）cm/s vs （11. 9 ±3. 8）cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8： with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; （7.7 ±2. 6） cm/s vs （9. 9 ± 2. 8） cm/s, E/Em： 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [（0. 90 ± 0. 22） cm/s vs （0. 87 ± 0. 17） cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.