高血压患者心房内和心房间不同步性的超声评价

Assessment of intra-and interatrial asynchrony in patients with hypertension

目的:研究高血压患者心房内和心房间的不同步性及其影响因素。方法:研究对象为32例正常体检者(对照组)、40例高血压无左室肥厚患者(NLVH组)、51例高血压伴左室肥厚患者(LVH组)。采用组织多普勒(TDI)技术,在心尖四腔观测量右心房游离壁、房间隔和左房游离壁各取样点处心电图P波开始到TDI A波开始的时差:P-RA、P-IAS、P-LA。不同步的定义是指:P-IAS和P-RA、P-LA和P-IAS、P-LA和P-RA之间的差值。结果:与对照组相比,NLVH组和LVH组存在显著的左房及心房间的不同步,LVH组与NLVH组相比,左房及心房间的不同步更加明显。多元逐步回归分析发现左房内不同步性与LVMI、血清NT-proBNP水平和年龄呈正相关。结论:高血压患者存在显著的左心房内、心房间不同步性,且左心房内不同步性与LVMI、NT-proBNP及年龄密切相关。

Objective： To assess intra-and interatrial asynchronicity in patients with hypertension by tissue Doppler imaging.Methods： Fourty patients with hypertension without left ventricular hypertrophy（NLVH group）,51 with left ventricular hypertrophy because of hypertension（LVH group）and 32 healthy subjects（Control group）were included.Color tis-sue Doppler imaging was used to evaluate intra-and interatrial asynchrony in the three groups.Measurements below the atrioventricular plane were selected on the right atrial（RA）free wall,interatrial septum（IAS）,and left atrial（LA）free wall.The time difference from the onset of the P wave to the onset of the A wave at the right atrium（P-RA）,the IAS（P-IAS）,and the left atrium（P-LA） was measured,respectively.Asynchrony was defined as the differ-ences between P-IAS and P-RA（RA asynchrony）,P-LA and P-IAS（LA asynchrony）,and P-LA and P-RA（interatrial asynchrony）.Results： Compared with the control group,LA and inter-atrial asynchrony was significantly increased in the NLVH and LVH groups.Compared with the NLVH group,LA and interatrial asynchrony was significantly increased in the LVH groups.Multiple factor stepwise regression analysis showed that LA asynchrony was related to left ventricular mass index（LVMI）,NT-proBNP and age.Conclusion： In patients with hypertension,significant LA and interatrial asynchrony are documented and evaluated by noninvasive color tissue Doppler imaging.LA asynchrony is positively correlated with the LVMI,NT-proBNP and age.