血流向量技术评估高血压病左室心功能的临床应用价值

Clinical value of flow vector technique in evaluating left ventricular function in hypertensive disease

目的探索血流向量技术(VFM)评估高血压患者左室血流动力学变化情况,了解VFM在评估高血压患者左室心功能的临床应用价值。方法选取2015年3月—2017年3月经安丘市人民医院和潍坊医学院附属医院就诊的原发性高血压病患者108例作为高血压组,并选取无高血压及相关性疾病的健康体检者108例作为健康对照组。采用彩色多普勒超声诊断仪测量受检者的左心室舒张末期内径(LVEDD)、左心室舒张末期后壁厚径(LVPWT)、舒张末期室间隔厚径(IVST)、左房前后径(LAD),计算左室心肌质量(LVM)=0.8×1.04[(IVST+LVEDD+PWT)~3-(LVEDD)~3]+0.6,左室心肌质量指数(LVMI)=LVM/体表面积,左室相对室壁厚度(RWT)=(IVST+PWT)/(LVEDD)。测量二尖瓣环于长轴的平均峰值舒张速度(Em)、平均舒张期峰值应变率(Esr)和平均峰值收缩速度(Sm)、平均收缩其峰值应变率(Ssr)。左室心尖段、中间段和基底段的等容收缩期(IVCT)、收缩早期(ES)、收缩中期(MS)、收缩晚期(LS)、等容舒张期(IVRT)、舒张早期(ED)、舒张中期(MD)、舒张晚期(LD)的涡流值。结果高血压组的LVEDD、LVPWT、IVST、LAD、LVEF及LVMI均高于健康对照组,且差异具有统计学意义(P<0.05)。高血压组心尖段ED、MD和LD的涡流量、中间段LS涡流量及基底段MD涡流量均明显高于健康对照组,且差异具有统计学意义(P<0.05)。各亚级高血压组心尖段MS和LS,中间段的IVCT、ES、MS和ED、MD,基底段的IVCT、ES、MS和IVRT、LD差异具有统计学意义(P<0.05)。高血压组的Em、Esr、Sm、Ssr低于健康对照组,差异具有统计学意义(P<0.05),高血压各亚组Em、Esr、Sm和Ssr对比差异无统计学意义(P>0.05)。结论 VFM能够准确量化心腔内血流状态,能够在无创性可视化条件下研究心腔血流动力学情况。测量的Em、Esr和Sm、Ssr能够准确评估高血压患者左室收缩与舒张功能,在评估左室收缩与舒张功能方面具有重要的临床应用价值。

Objective To explore the blood flow vector technology （VFM） evaluation of hypertension patients with left ventricular hemodynamic changes, understand the VFM in evaluating the clinical value of hypertension patients with left ventricular cardiac function. Methods From March 2015 to March 2017, a total of 108 patients with essential hypertension （EH） in Anqiu City People＇s Hospital and Affiliated Hospital of Weifang Medical University were enrolled, the patients with high blood pressure as high blood pressure group, and 108 patients without hypertension or related disease were enrolled as healthy controls. The left ventricle was measured with color Doppler ultrasound of end diastolic dianmtor （ LVEDD）, left ven- tricular end diastolic wall thickness after diameter （ LVPWT）, end diastolic ventricular septal thickness （IVST）, left atrial di- ameter （ LAD）, the calculation of left ventricular mass （ LVM ）, LVM = 0. 8 × 1.04 [ （ IVST ＋ LVEDD ＋ PWT）^ 3 - （LVEDD）^3] ＋0.6, the surface area of LVMI = LVM/BSA, the relative left ventricular wall thickness （RWT） = （IVST ＋ PWT）/（ LVEDD）, The mean peak diastolic velocity （ Em）, mean diastolic peak strain rate （Esr）, mean peak systolic velocity （Sm） and peak systolic strain rate （Ssr） of mitral annulus were measured. The systolic phase （IVCT）, early systolic phase （ES）, mid systolic （MS）, late systolic phase （LS）, isometric diastole （IVRT）, early diastole （ED）, middle diastole （MD） and late diastolic （LD） of left ventricular apex, middle and basal segments were observed. Results LVEDD, LVPWT, IVST, LAD, LVEF and LVMI of hypertension group were all higher than normal control group, and the difference was statistically significant （P 〈 0.05）. The flow volume of ED, MD and LD in the apical segment of the hypertension group, and the LS vortex flow in the middle section and the MD vortex flow at the basal segment of the hypertension group were Significantly higher than those in the healthy control group, and the difference was statistically significant （P 〈 0.05 ）. There were statis- tically significant differences in apical segment MS and LS, IVCT, ES, MS and ED, MD, basal segment IVCT, ES, MS and IVRT and ES among all sub hypertension group （P 〈0.05）. The levels of Em, Esr, Sm and Ssr in hypertension group were lower than those in healthy control group （P 〈 0.05）. There was no statistically significant difference in Em, Esr, Sm and Ssr among all hypertensive subgroups （P 〉 0.05 ）. Conclusion VFM can accurately quantify the blood flow in the heart cham- ber, and can evaluate the hemodynam!cs of the heart chamber without invasive visualization. The measurement of Em, Esr and Sm and Ssr can accurately assess left ventricular systolic and diastolic function in hypertensive patients, and have important clinical application value in evaluating left ventricular systolic and diastolic function.