二维应变成像评价原发性高血压患者左心室长轴收缩功能

Evaluation of left ventricular long-axis systolic function in patients with essential hypertension using two dimensional strain imaging

目的应用二维应变成像技术检测原发性高血压患者左心室长轴收缩功能的变化,探讨其临床应用价值。方法选择2010年8月至2011年8月我院门诊和住院的原发性高血压患者61例,分为非室间隔心肌肥厚的原发性高血压患者组(非室间隔肥厚组)30例和室间隔心肌肥厚的原发性高血压患者组(室间隔肥厚组)31例;选取年龄和性别匹配的健康志愿者30例为健康对照组。分别采集心尖四腔心切面、心尖两腔心切面和心尖左心室长轴切面的二维动态图像,应用二维应变成像技术获取左心室18个心肌节段收缩期峰值应变的牛眼图、左心室3个心尖切面的峰值收缩总应变及左心室整体心肌应变。结果健康对照组、非室间隔肥厚组、室间隔肥厚组受检者心尖左心室长轴切面总应变分别为(-19.8±2.0)%、(-20.5±1.9)%、(-14.8±2.1)%,差异有统计学意义(F=73.84,P<0.01);室间隔肥厚组与健康对照组、非室间隔肥厚组比较,差异亦均有统计学意义(q=13.79、15.72,P均<0.01)。3组受检者心尖四腔心切面总应变分别为(-19.4±1.9)%、(-16.3±1.8)%、(-15.1±1.9)%,差异有统计学意义(F=42.82,P<0.01);非室间隔肥厚组、室间隔肥厚组与健康对照组比较,差异均有统计学有意义(q=9.07、12.71,P均<0.01);非室间隔肥厚组与室间隔肥厚组比较,差异亦有统计学意义(q=26.16,P<0.01)。3组受检者心尖两腔心切面总应变分别为(-22.0±1.7)%、(-21.8±1.6)%、(-15.1±1.7)%,差异有统计学意义(F=150.62,P<0.01);室间隔肥厚组与健康对照组、非室间隔肥厚组比较,差异均有统计学意义(q=26.82、3.55,P均<0.05)。3组受检者左心室整体心肌应变分别为(-20.5±1.8)%、(-18.9±1.7)%、(-15.0±1.6)%,差异有统计学意义(F=84.68,P<0.01);非室间隔肥厚组、室间隔肥厚组与健康对照组,非室间隔肥厚组与室间隔肥厚组比较,差异均有统计学意义(q=5.15、17.86、12.66,P均<0.01)。结论二维应变成像技术能够在原发性高血压患者左心室长轴收缩功能出现明显改变前显示部分心肌节段收缩功能的降低,从而为早期发现原发性高血压患者心肌病变提供了无创性的检测方法。

Objective To evaluate the left ventricular long-axis systolic function in patients with essential hypertension （EH） by using two dimensional strain imaging and to investigate its clinical significance.Methods During August 2010 to August 2011,61 patients with hypertension and 30 healthy volunteers （group A） were enrolled.61 hypertensive patients were divided into two groups：30 hypertensive patients without septal hypertrophy （group B） and 31 hypertensive patients with septal hypertrophy （group C）.Two-dimensional images with high frame rate were obtained from the apical four-chamber view,two-chamber view and long-axis of the left ventricle.The peak systolic longitudinal strain of 18 segments and 3 whole views were measured using two-dimensional strain software,and eventually the strain of 18 segments were showed in Bull′s eye patterns.Results The global peak systolic strain of the apical long-axis of the left ventricle view（GLPS-LAX）were （-19.8±2.0）%,（-20.5±1.9）%,（-14.8±2.1）% in group A,group B and group C respectively.There were significant differences among the groups （F=73.84,P〈0.01）.In detail,the significant differences were identified in following comparisons：group A/B with C （q=13.79, 15.72,all P〈0.01）.The global peak systolic strain of the apical four-chamber view （GLPS-A4C） were （-19.4±1.9）%,（-16.3±1.8）%,（-15.1±1.9）% in group A,group B and group C respectively.There were significant differences among the groups （F=42.82,P〈0.01）. In detail,the significant differences were identified in following comparisons：group B/C with A （q=9.07,12.71,all P〈0.01）,group B with C （q=26.16,P〈0.01）.The global peak systolic strain of the apical two-chamber view （GLPS-A2C） were （-22.0±1.7）%, （-21.8±1.6）%, （-15.1±1.7）% in group A,group B and group C respectively.There were significant differences among the groups （F=150.62,P〈0.01）.In detail,the significant differences were identified in following comparisons：group A/B with C （q=26.82,3.55,all P〈0.05）.The average global peak systolic longitudinal strain of 3 whole views （GLPS-Avg） were （-20.5±1.8）%,（-18.9±1.7）%,（-15.0±1.6）% in group A,group B and group C respectively.There were significant differences among the groups （F=84.68,P〈0.01）.In detail,the significant differences were identified in following comparisons：group B/C with A （q=5.15,17.86,all P〈0.01）,group B with C （q=12.66,P〈0.01）.Conclusions Two dimensional strain imaging can show the local systolic dysfunction prior to the global changes in patients with hypertension.Two dimensional strain imaging is a promising approach to be used clinically to evaluate the left ventricular systolic function in hypertension patients.