超声心动图评价原发性高血压患者二尖瓣环与主动脉瓣环平面夹角变化与左心室收缩功能关系的初步研究

The preliminary echocardiography study to evaluate the correlation between the aortomitral angle changes with left ventricular systolic function among the primary hypertension patients

目的采用超声心动图评价原发性高血压左室正常构型（LVN）患者二尖瓣环与主动脉瓣环平面夹角（AMA）的变化及其与左室收缩功能的关系。方法纳入54例LVN高血压患者作为LVN组，79例健康人作为对照组，行常规超声心动图检查，采集连续5个心动周期的二维灰阶动态图像，于胸骨旁左室长轴观依次测量组织多普勒（TDI）频谱对应的等容收缩期起始（S-IVCT）、S波顶点（SP）、等容舒张期起始（S-IVRT）、舒张期起始（SD）对应的AMA，计算角度差（△θ）、角度变化率；使用二维斑点追踪定量分析软件获取左室整体纵向应变（GLS）及整体周向应变（GCS）；采用Simpson双平面法测量左室射血分数（LVEF）。结果与对照组相比，LVN组△θ及各个时相的AMA均增大（P〈0．05），LVN组GCS较对照组增高（P〈0．05）；对照组S-IVCT的AMA与GLS、GCS及LVEF均有相关性（r=-0．18，P=0．04；r=-0．17，P=0．04；r=-0．19，P=0．03）。结论LVN高血压患者AMA角度显著大于正常人群数值，可能与维持有效的左室收缩功能有关，其可作为一项量化指标辅助评估LVN高血压患者的左心室重构情况。

Objective To evaluate the aortomitral angle （AMA）changes in primary hypertension patients with left ventricular normal configuration （LVN） by echocardiography, and explore the correlation with left ventricular systolic function. Methods LVN group included 54 patients, control group included 79 healthy subjects. All subjects were examined by conventional echocardiography, the 2-dimensional grayscale dynamic images of 5 consecutive cardiac cycles were collected by routine echocardiography; from parasternal left ventricular long axis, the related AMA at the starting isovolumic contraction time （S- IVCT）, S-wave peak（SP）, starting isovolumic relaxation time（S-IVRT）, and starting-end diastole（SD） were measured respectively based on the tissue Doppler imaging, calculating the angle difference（△θ） as well as the rate of the angle change. The global systolic longitudinal strain（GLS） and circumferential strain （GCS） of left ventricle were measured by 2-dimensional speckle tracking and quantitative analysis software. Left ventricular ejection fraction （LVEF） was measured by Simpson＇s biplane method. Results Compared with control group, the △θ and AMA of each phases in cardiac cycles of LVN group were increased （ P〈 0.05） ;Compared with control group, the GCS of the left ventricular was increased in LVN group （ P 0.05）. There was a correlation between AMA of the S-IVCT and that of GLS or OCS,and the LVEF of the left ventricular in the control group （ r = - 0.18, P = 0.04; r = - 0.17, P = 0.04; r = - 0.19, P = 0.03）. Conclusions AMA angle in patients with LVN is significantly greater than the normal population value, which may be to maintain effective left ventricular systolic function and could be used as an quantitative indicator to assess the left ventricular remodeling in patients with LVN.