原发性高血压患者左室重构对右心舒张功能的影响

Effects of left ventricular remodeling on right ventricular diastolic function in patients with essential hypertension

目的利用脉冲多普勒评价原发性高血压患者心室重构及舒张功能的改变。方法随机选择原发性高血压患者126例(高血压组),按照左室质量指数(LVMI)分为左室肥厚(LVH)组66例和无左室肥厚(NLVH)组60例。对照组为体检健康者(40例)。M型及二维超声常规测量,转为组织多普勒(TDI)测量左房室瓣环侧壁处(LVAP)、右房室瓣环侧壁处(RVAP)组织舒张早期(Em)与舒张晚期(Am)的速度峰值,并计算Em/Am比值。结果 LVH组、NLVH组的IVS、LA、LVPW、RVAW均值分别为(12.2±0.9)mm、(42.9±3.1)mm、(12.3±0.8)mm、(5.4±1.0)mm和(9.5±1.4)mm、(39.1±3.0)mm、(8.9±1.2)mm、(4.5±0.7)mm,对照组则分别为(8.3±0.7)mm、(35.4±2.2)mm、(7.8±1.0)mm、(4.3±0.7)mm,LVH组的IVS、LA、LVPW、RVAW与NLVH组和对照组比较明显增加,差异均有统计学意义(P<0.05);LVH组RVAP处的Em及Em/Am比值分别为(8.8±2.5)cm/s、(0.59±0.17),LVAP处分别为(9.1±2.2)cm/s、(0.58±0.15),NLVH组RVAP处的Em及Em/Am比值分别为(11.3±2.5)cm/s、(0.77±0.15),LVAP处分别为(11.8±2.4)cm/s、(0.91±0.09),对照组RVAP处的Em及Em/Am比值分别为(13.8±3.1)cm/s、(1.09±0.21),LVAP处分别为(13.5±3.8)cm/s、(1.13±0.19)。LVH组、NLVH组RVAP、LVAP处的Em及Em/Am比值均明显低于对照组,差异均有统计学意义(P<0.05);LVH组RVAP及LVAP的Em及Em/Am比值低于NLVH组,差异均有统计学意义(P<0.05)。结论原发性高血压早期可出现右心舒张功能的减退,随病程发展出现左室肥厚时可进一步影响右室重构及右室功能。

Objective To evaluate ventricular remodeling and diastolic function changes in patients with primary hypertension by pulsed Doppler. Methods A total of 126 patients with essential hypertension were selected and divided them into the left ventricular hypertrophy group（Group LVH, with 66 cases） and non left ventricular hypertrophy group（Group NLVH, with 60 cases） according to the left ventricular mass index（LVMI）. And 40 of healthy people were selected as the control group. Routine tests of Type M and two-dimensional ultrasonography were performed,the early（Em） and late（Am） diastolic peak velocity of the left（LVAP） and right（RVAP） atrioventricular valve ring wall by adopting tissue Doppler imaging（TDI） were measured, then the ratio of Em/Am was calculated. Results The mean value of IVS, LA, LVPW and RVAW of Group LVH and Group NLVH, were respectively（12.2±0.9） mm,（42.9±3.1） mm,（12.3±0.8） mm,（5.4±1） mm and（9.5±1.4） mm,（39.1±3） mm,（8.9±1.2） mm,（4.5±0.7） mm. The mean values of control group were（8.3 ± 0.7） mm,（35.4 ± 2.2） mm,（7.8 ± 1） mm,（4.3 ± 0.7） mm. The IVS, LA, LVPW, RVAW of Group LVH increased significantly than those of Group NLVH and control group. The differences were statistically significant（P〈0.05）. In Group LVH, the Em and Em/Am ratio of RVAP and LVAP were respectively（8.8 ± 2.5） cm/s,（0.59 ± 0.17） cm/s and（9.1 ± 2.2） cm/s,（0.58 ± 0.15） cm/s. In Group NLVH, the Em and Em/Am ratio of RVAP and LVAP were respectively（11.3 ± 2.5） cm/s,（0.77±0.15） cm/s and（11.8±2.4） cm/s,（0.91±0.09） cm/s. In control group,the Em and Em/Am ratio of RVAP and LVAP were respectively（13.8 ± 3.1） cm/s,（1.09 ± 0.21） cm/s and（13.5±3.8） cm/s,（1.13±0.19） cm/s. The Em and Em/Am ratio of RVAP and LVAP in Group LVH and Group NLVH were both significantly lower than those of the control group. The differences were statistically significant（P〈0.05）. The Em and Em/Am ratio of RVAP and LVAP in Group LVH were lower than those in Group NLVH. The differences were statistically significant（P〈0.05）. Conclusion Impairment of right ventricular diastolic function can occur in early essential hypertension. With the course of development, left ventricular hypertrophy may further influence the remodeling and function of right ventricular.