实时三维超声心动图定量评价原发性高血压病患者左室重构与收缩同步性的临床研究

Quantitative evaluation of the left ventricular remodeling and systolic synchrony in patients with essential hypertension by real-time three-dimensional echocardiography

目的应用实时三维超声心动图(RT-3DE)对原发性高血压病患者左室重构及收缩同步性进行定量评价,并探讨两者的相关性。方法选取102例原发性高血压病患者(正常构型组34例、向心性肥厚组34例、离心性肥厚组34例)和30例健康体检者,分别用RT-3DE测量其左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室射血分数(LVEF)、左室心肌质量指数(LVMI)、左室重构指数(LVRI)和经心动周期校正的左室16节段达最小收缩容积时间的标准差(Tmsv16-SD%,即SDI)和最大差值(Tmsv16-Dif%)。比较各组间差异,并对两类指标行相关性分析。结果与正常对照组相比,正常构型组SDI增大(P<0.05);向心性肥厚组除LVESV、LVEF外,余参数均增大(P<0.05);离心性肥厚组除LVRI外,余参数均增大(P<0.05)。高血压病患者SDI、Tmsv16-Dif%分别与LVEDV、LVESV、LVMI呈显著正相关(r=0.674,0.692,0.656及0.606,0.615,0.602,均P<0.01);与LVEF呈负相关(r=-0.560、-0.486,P<0.01);与LVRI无显著相关性。结论高血压病患者可出现不同程度的左室重构和室壁运动的不同步,且随着重构的发展,左室收缩不同步性增加。

Objective To evaluate left ventricular remodeling and systolic synchrony in patients with essential hy- pertension quantitatively by real-time three-dimensional echocardiography （RT-3DE） , and to explore the correla- tion between the two. Methods 30 healthy volunteers and 102 patients with essential hypertension were selected, including 34 cases of normal geometry, 34 cases of concentric hypertrophy, 34 cases of eccentric hypertrophy. RT- 3DE was used to measure its left ventricular end-diastolic volume （LVEDV） , left ventricular end-systolic volume （LVESV） , left ventricular ejection fraction （LVEF）, left ventricular mass index （LVMI）, left ventricular remode-ling index （LVRI）, the standard deviation （systolic dyssynchrony index, SDI ） and the maximum difference （Tmsvl6-Dif%） of left ventricular 16 segment systolic volume peak time respectively. Relevant differences were analyzed and compared, and correlation analysis was performed between parameters of left ventricular remodeling and synchronization index. Results Compared with normal control group, in addition to the SDI of normal geome- try group increased （P 〈 0.05）, in addition to the LVEDV, LVESV, LVEF of concentric hypertrophy group, the remaining parameters were increased （P 〈 0.05）. In addition to the LVRI of eccentric hypertrophy group, the re- maining parameters were larger than normal control group （P 〈 0.05 ）. SDI and Tmsvl 6-Dif% had positive correla- tion with LVEDV, LVESV and LVMI respectively （ r = 0. 674,0. 692,0. 656 and 0. 606,0. 615,0. 602, all P 〈 0.01 ） ,and had negative correlation with LVEF（ r = - 0. 560 and - 0. 486, all P 〈 0. 01 ） , and had no significant correlation with LVRI. Conclusion Hypertensive patients may present different degrees of left ventricular remode- ling and wall motion dyssynchrony. With the development of left ventricular remodeling, left ventricular systolic dys- synchrony increases.