斑点追踪技术评价无左心室肥厚高血压患者左心室扭转与解旋运动

Left ventricular twisting and untwisting by speckle tracking imaging in hypertensive patients without left ventricular hypertrophy

目的探讨无左心室肥厚高血压患者左心室扭转与解旋运动的特点。方法入选无左心室肥厚的高血压患者85例及健康对照者40名,应用超声二维斑点追踪技术(2D-STI)测量并计算短轴心尖部旋转峰值(PAR)及达峰时间、基底部旋转角度峰值(PBR)及达峰时间、左心室整体扭转角度峰值(Ptw)及达峰时间,收缩末期扭转角度(AVCtw)、等容舒张末期扭转角度(MVOtw)、解旋减半时间(HTU)、解旋率。结果高血压组PAR、Ptw、AVCtw、MVOtw高于对照组[(10.55±4.14)°比(8.95±3.46)°,(18.18±4.58)°比(16.33±4.50)°,(17.11±4.82)°比(14.95±4.61)°,(14.33±4.43)°比(12.40±4.86)°,均P<0.05],解旋率低于对照组[(36.06±15.98)%/ms比(48.96±21.16)%/ms,P<0.05]。Ptw与PAR呈正相关,与PBR呈负相关(分别r=0.825,-0.474,均P<0.05);Ptw与LVMI呈正相关(r=0.208,P<0.05),解旋率与左心室质量指数(LVMI)呈负相关(r=-0.231,P<0.05)。结论高血压患者左心室扭转及解旋运动的异常早于室壁厚度的增加,2D-STI技术可定量检测左心室扭转与解旋运动,有可能作为评价高血压患者左心室收缩及舒张功能的早期指标。

Objective To investigate the characteristics of left ventricular（LV） twist and untwist in hypertensive patients without left ventricular hypertrophy（LVH）.Methods Eighty-five hypertensive patients without LVH and 40 healthy subjects were enrolled in this study.The LV rotation was obtained in the short-axis views using 2D-strain software.Apical peak rotation（PAR）,basal peak rotation（PBR）,time to peak on basal and apical plane,LV peak twist（Ptw） and time to peak were measured separately.Twist at aortic valve closure（AVCtw）,twist at mitral valve opening（MVOtw）,untwisting rate（UntwR）,and half time of untwisting（HTU） were calculated.Results Compared with the normal group,the values of PAR,Ptw,AVCtw,MVOtw were increased ／[（10.55±4.14）° vs（8.95±3.46）°,（18.18±4.58）° vs（16.33±4.50）°,（17.11±4.82）° vs（14.95±4.61）°,（14.33±4.43）° vs（12.40±4.86）°,P0.05／] and UntwR was decreased ／[（36.06±15.98）%/ms vs（48.96±21.16）%/ms,P0.05／] in hypertensive patients without LVH.Ptw was correlated positively with PAR（r=0.825,P0.05） and negatively with PBR（r=-0.474,P0.05）.There was a positive correlation between Ptw and LVMI（r=0.208,P0.05） and a negative correlation between UntwR and LVMI（r=-0.231,P0.05）.Conclusion LV twist and untwist measured by speckle tracking echocardiography has changed before wall thickness abnormality,and may be used as the index for early assessing LV systolic and diastolic functions in hypertensive patients.