原发性高血压不同左室构型对左室功能的影响

The Effect of Different Left Ventricular Configuration of Primary Hypertension to Left Ventricular Function

目的 探讨原发性高血压不同左室构型对左室功能的影响。方法 根据Ganau’s分类法将 72例原发性高血压患者分为正常左室构型组 ,向心性重构组 ,向心性肥厚组、离心性肥大组。运用超声心动图和彩色多普勒技术检测各组LVEF、CO、CI、SV ;二尖瓣口E、A峰 ,E、A峰流速积分 (EVI、AVI)及E/A、EVI/AVI和IVRT ,并与正常组对照。结果 ①向心性重构组CI、SV值降低、离心性肥大组LVEF值降低 ,高血压各组E/A、EVI/AVI、A峰、AVI、IVRT有改变 ,与对照组比较有显著性差异 ;②高血压各组间多无显著性差异。③向心性肥厚和离心性肥大组可有E/A <1、1<E/A <2 .0、E/A>2 .0三种模式 ,其中 1<E/A <2 .0可为假性正常。结论 ①原发性高血压不同左室构型可引起左室收缩、舒张功能不同程度损害 ,而舒张障碍先于收缩障碍。②血流多普勒法评价左室舒张障碍有其局限性。

Objective To investigate the effect of different left ventricular (LV) configuration of primary hypertension to LV function. Methods Four groups were divided in 72 cases patients with primary hypertension, including normal LV configuration group, concentric remodeling group, concentric hypertrophy group, centrifugal hypertrophy group, according to Ganau's categories. We measured LVEF, CO, CI, SV, E together with A peak flow velocity during diastole, EVI and AVI by echocardiography and color Doppler flow image, and compared these parameters with the control group. Results ①CI and SV decreased in concentric remodeling group, so did LVEF in centrifugal hypertrophy group, and both had significant difference compared with the controls.②E/A, EVI/AVI, A peak, AVI, IVRT differed significantly between the hypertension groups and the normal group, but there was no statistical difference among the hypertension groups.③E/A<1, 1<E/A<2.0, E/A>2.0 three flow models were displayed in both concentric hypertrophy group and centrifugal hypertrophy group, however 1<E/A<2.0 sometimes was false normalization. Conclusion ①Different configuration in primary hypertension can cause LV systolic and diastolic dysfunction and the latter was prior to the former. ②There was limitation in evaluating LV diastolic function by Doppler echocardiography.