应用血流向量成像评价不同构型高血压患者左心室舒张功能

Study of left ventricular diastolic function in hypertensive patients with different left ventricular geometric patterns by vector flow mapping

目的应用血流向量成像（VFM）技术评价不同构型高血压患者舒张期左室血流动力学变化特征。方法选取169例高血压患者为病例组，根据2005年ASE标准将高血压患者分为4种左室构型：正常构型、向心性重构型、向心性肥厚型、离心性肥厚型；选取50例健康志愿者为对照组。比较病例组各种构型及对照组之间左室心尖段、中间段、基底段的平均能量损耗（aEL）及循环在舒张期不同时相的变化，并与E／e’进行相关性分析。结果①组间比较，各病例组心房收缩期3个节段的aEL均较对照组显著增高（P〈0．05）；离心性肥厚组心房收缩期的心尖段和中间段的aEL明显高于对照组、正常构型组和向心性重构组，基底段的aEL明显高于其他3个病例组，差异均具有统计学意义（PG0．05）。②各病例组快速充盈期二尖瓣前叶循环明显低于对照组，差异有统计学意义（P〈0．05）；各病例组心房收缩期二尖瓣后叶循环明显高于对照组（Pd0．05），向心性肥厚组明显高于正常构型组（P〈0．05），离心性肥厚组明显高于正常构型组及向心性重构组（P〈0．05）。②组内比较，同一节段各时相以及同一时相各节段aEL比较差异均有统计学意义（PG0．05）；③高血压组心房收缩期基底段aEL与E／e’呈正相关（r=0．66，P〈0．01）。结论VFM技术能够准确反映高血压不同构型患者舒张期左心室血流动力学变化特征，能为评价不同构型高血压患者左室舒张功能受损程度提供量化指标。

Objective To assess the clinical application value of vector flow mapping evaluating the left ventricular diastolic function in hypertensive patients with different left geometric patterns. Methods One hundred and sixty-nine patients with hypertension and volunteers were enrolled. Hypertensive patients were divided into four groups with different configurations according to ASE guide line in 2005 ： normal geometry group, concentric remodeling group, concentric hypertrophy group and eccentric hypertrophy group. The quantitative parameters, including average energy loss（aEL） and circulation were measured. Difference was evaluated among five groups at apical, mid and basal segments and at different periods. The correlationship was analyzed between aEL, circulation and E/e＇, respectively. Results①Compared to control group, aEL was higher in four hypertension groups at three segments of atrial systole（ P〈0.05）. aEL in eccentric hypertrophy group was higher than those in control group, normal geometry group or concentric remodeling group at apical and mid segments of atrial systole, and higher than those in other hypertensive groups at basal segment（ P〈0.05）. In four hypertension groups, circulations in rapid filling phase of anterior mitral valve were lower than that in control group, but circulations in slow filling phase of posterior mitral valve were higher than that in control group（ P〈0.05）. The circulation in slow filling phase of posterior mitral valve in concentric remodeling group was higher than that in normal geometry group, and that in eccentric hypertrophy group was higher than those in normal geometry group and concentric remodeling group（ P〈0.05）. ②When intra-group comparison,aEL were different in different segments of same phase or at different phases of same segment（ P 〈0.05）. ③aEL had a good correlation with E/e＇ at basal segment of atrial systole in four hypertension groups（ r = 0.66, P 〈0.01 ）. Conclusions VFM can be utilized to analyze left ventricular hemodynamics features of hypertensive patients with different left ventricular geometric patterns, it may be a good supplement for assessing cardiac diastolic function and reflect the extent of damage.