斑点追踪应变超声评价原发性高血压左室心肌收缩功能的研究

ASSESMENT OF LEFT VENTRICULAR MYOCARDIAL SYSTOLIC FUNCTION IN PRIMARY HYPERTENSION BY SPECKLE TRACKING ECHOCARDIOGRAPHY

目的分析伴有、不伴有左室向心性肥厚的原发性高血压患者及正常人群左室壁各方向的应变,评价向心性肥厚对左室壁收缩功能的影响。方法本研究对68例原发性高血压患者(PH)和32例正常对照组进行斑点追踪应变分析,所有PH患者左室整体收缩功能正常即左室射血分数(LVEF)≥55%,根据左室质量指数(LVMI)将PH患者分为左室向心性肥厚组(Ⅰ组)和左室正常构型组(Ⅱ组)。常规测量二维多普勒超声心动图参数并运用二维斑点追踪应变成像技术(2DSTE)测量各应变参数,于左室短轴乳头肌水平及二尖瓣环水平二维动态图像分析各应变值,包括整体收缩期径向应变峰值(GRS)、收缩期整体圆周应变峰值(GCS),节段心肌收缩期径向应变峰值(Rs)及节段心肌收缩期圆周应变峰值(Cs);于心尖长轴、两腔及四腔长轴二维动态图像分析整体收缩期纵向应变峰值(GLS)及节段心肌收缩期纵向应变峰值(Ls)。对各组常规超声参数及应变参数进行比较及相关性分析。结果比较分析Ls、Cs及Rs,Ⅰ组高于Ⅱ组及对照组(P<0.05),Ⅱ组与正常对照组差异无统计学意义(P≥0.05);Ⅰ组、Ⅱ组与正常对照组三组间GLS、GRS、GCS差异无统计学意义(P≥0.05);相关性分析:Ⅰ组的Ls与LVMI、RWT呈正相关(r=0.74,P<0.05;r=0.23,P<0.05),Cs与LVMI、RWT呈正相关(r=0.31,P<0.05;r=0.34,P<0.05),Rs与LVMI、RWT呈正相关(r=0.45,P<0.05;r=0.52,P<0.05)。结论应用2DSTE发现左室整体收缩功能正常的PH伴有左室向心性肥厚患者心肌纵向及圆周方向的收缩功能首先发生了减低,2DSTE能够客观及正确的评估PH左心室收缩功能并具有识别原发性高血压高危心衰患者的潜在临床价值。

Objective To evaluate the influences of hypertrophy to left ventricular （LV） systolic function by study differential Strain in patients with primary hypertension （PH） with or without LV hypertrophy.Methods In 68 PH and 32 healthy controls, differential strain was detected by Two- dimensional speckle tracking echocardiography （2DSTE）. All PH patients have nomal ejection fraction（LVEF）, that LVEF≥55%. All the PH patients were divided into LV hypertrophy group （ Ⅰ ） and normal geometry group（ Ⅱ ）according to left ventricular mass index（LVMI）. The Basic Information was measured by conventional Two-dimensional Doppler Echocardiography in 68 PH patients and 32 normal controls. Peak global radial strain（GRS）, global circumferential strain（GCS）, peak systolic radial strain（Rs） of segmental myocardium and peak systolic circumferential strain（Cs）of region myocardium were measured in parasternal short axis at the basal, middle, and apical level. Peak systolic global longitudinal strain（GLS）and peak systolic longitudinal strain（Ls）of segmental myocardium were measured in the apical long axis, 2 - and 4- chamber views. All strain were com- pared, and the relationship was analyzed between above measurements and the indices of conventional echocardiography and etc.Results Comparing the differential strain of segmental myocardium among the groups, Ls, Cs and Rs in group Ⅰ were higher than group Ⅱ and normal controls group（P〈0.05）, there were no significant difference in group Ⅱ and normal group（P≥0.05）. There were no significant differences in the differential strain of global myocardium among the three groups（P≥0.05）. In the group Ⅰ , univariate correlation analysis showed that LVMI and RWT was positively correlated with Ls （r = 0.74, P〈0.05;r = 0.23, P 〈0.05） ; LVMI and RWT was positively correlated with Cs （r = 0.31, P〈0.05;r = 0.34, P〈0.05） ; LVMI and RWT was positively correlated with Rs （r = 0.45, P〈0.05;r = 0.52, P〈0.05）. Of the three directional strain,Ls showed the strong correlation with LVMI.Conelusion The longitudinal and circumferential systolic function associated with strain of LV hypertrophy patients are damaged in comparison with normal geometry patients and normal individuals, which can be detected conveniently and accurately using twodimensional speckle tracking eehocardiography. It can potentially be used to identify patients at high risk for heart failure.