原发性高血压早期患者组织多普勒参数改变与左心房构型的相关性研究

Parameter changes of tissue Doppler imaging in patients with early essential hypertension and its correlation with atrial geometric pattern

目的分析原发性高血压(essential hypertension,EH)早期患者二尖瓣侧壁处瓣环、室间隔处瓣环舒张早期峰值速度比(lateral Em/septum Em,LEm/SEm)与左心房构型的相关性。方法 EH组160例,按病情进展将组织多普勒改变分为两组,EHⅠ组:SEm<SAm,LEm>LAm,共80例;EHⅡ组:SEm<SAm,LEm<LAm,共80例;健康对照组40例。所有受检者均经胸常规超声心动图及组织多普勒检查。记录常规超声心动图左心房、左心室相关测量参数,脉冲多普勒二尖瓣口血流图E峰、A峰及E/A值,脉冲组织多普勒二尖瓣环室间隔处、侧壁处瓣环Em、Am及Em/Am值。分析LEm/SEm与E/A、E/SEm、等容舒张期(IVRT)及左心房前后径(LAD)的相关性。以左心房前后径40mm作为左心房增大的标准,通过ROC曲线分析LEm/SEm最合适的诊断临界值。结果 (1)LEm/SEm与E/A、E/SEm、IVRT及LAD均有较好的相关性,其相关系数r分别为0.55(P<0.01)、0.62(P<0.01)、-0.26(P<0.01)和-0.51(P<0.01);(2)LEm/SEm评价左心房增大的截断点为1.33,灵敏度为92%,特异度为80%。结论 LEm/SEm与EH患者左心房构型具有较好的相关性,有望成为评价EH患者左心室舒张功能和左心房构型的新指标。

Objective To investigate the correlation of echocardiographic parameters of tissue Doppler imaging with left atrial geometric pattern in patients with early essential hypertension （EH）.Methods One hundred sixty patients with early EH were enrolled in the study,including 80 patients with septum Em＜septum Am,lateral Em ＞ lateral Am （group EH I） and another 80 patients with septum Em＜septum Am,lateral Em＜lateral Am （group EH Ⅱ） ; 40 healthy subjects served as control group.All subjects underwent conventional transthoracic echocardiography and tissue Doppler imaging echocardiography.The conventional echocardiographic related parameters of left atrium and left ventrical,mitral valve blood chart peak E,peak A and E/A under pulse Doppler imaging,lateral and septum Em,Am and Em/Am under pulse tissue Doppler imaging were documented.The correlations of LEm/SEm with E/A,E/SEm,isovolumic relaxation phase （IVRT） and left atrial diameter （LAD） were analyzed.With the ROC curve,the cut-off point of LEm/SEm for diagnosis of left atrial enlargement was obtained.Results There were significant correlations of LEm/SEm with E/A,E/SEm,IVRT and LAD （r=0.55,0.62,-0.26 and-0.51,respectively,P＜0.01）.Taking 1.33 as cut-off point of LEm/SEm on ROC curve the sensitivity and specificity of LEm/SEm for diagnosis of left atrial enlargement were 92％ was 80％,respectively.Conclusion There is a significant correlation between LEm/SEm and left atrial geometric pattern.It may be used as a novel parameter for the evaluation of left ventricular diastolic function and Left atrial geometric pattern.