二维斑点追踪成像评价高血压无左心室肥厚患者心房内和心房间不同步运动

目的探讨高血压无左心室肥厚患者的心房内和心房间不同步运动特征。方法对38例正常人、40例高血压无左心房增大患者和28例高血压伴左心房增大患者行超声心动图检查，常规测量和计算左心室结构和功能参数、二尖瓣口血流频谱E／A比值。获取心尖四腔切面的右心房游离壁、房间隔和左心房游离壁二维宽点追踪图像后，测量心电图P波起始点至二维斑点追踪图像上舒张期第二个负向波的时间间期，即右心房游离壁电-机械运动时间（P—RA）、房间隔电-机械运动时间（P—IAS）和左心房游离壁电-机械运动时间（P—LA），并计算心房同步性：右心房房内同步性=P-RA和P—IAS之差，左心房房内同步性=P—LA和P—IAS之差，左右心房间同步性=P—RA和P—LA之差。结果高血压伴左心房增大组的E／A低于对照组，差异有统计学意义高血压伴左心房增大组的P—LA较对照组和高血压无左心房增大组均明显增加，差异均有统计学意义，左心房房内同步性和左右心房间同步性在对照组、高血压无左心房增大组、高血压伴左心房增大组呈逐渐变差趋势，两两比较差异均有统计学意义。P-LA、左心房房内同步性和左右心房间同步性与高血压、左心房增大和E／A均呈显著性相关，其中P-LA、左心房房内同步性和左右心房间同步性均与左心房增大的相关性最好。结论高血压无左心室肥厚患者的左心房房内同步性和左右心房间同步性均变差，且与左心房增大关系密切。

Objective To evaluate the intra-atrial and inter-atrial asynchrony in essential hypertension patients without left ventricular hypertrophy by two-dimensional speckle tracking imaging. Methods The echocardiographic examination were performed in 38 normal adults, 40 essential hypertension patients without left atrial enlargement and 28 essential hypertension patients with left atrial enlargement. The structural and functional parameters of left ventricle and mitral flow E/A ratio were measured and calculated. After two-dimensional speckle tracking images of the right atrium free wall, atrial septum and left atrium free wall were obtained at apical four chamber view. The time interval from the initial point of P wave on ECG to second negative waves in the diastolic phase of two-dimensional speckle tracking images were measured, ineulding the electrical-mechanical time of the right atrium free wall （ P-RA ） , the electrical-mechanical time of atrial septum （ P-IAS ） , and the electrical-mechanical time （ P-LA ） of left atrium free wall, respectively. Atrial synchrony was calculated as the following., right atrial intra-atrial synchrony=the difference of P-RA and P-IAS, left atrial intra-atrial synchrony=the difference of P-LA and P-IAS, inter-atrial synchrony between left atrial and right atrial=the difference of P-RA and P-LA. Results E/A was lower in patients with hypertension and left atrial enlargement than that in the control group, and the differences was statistically significant. The P-LA was significantly higher in patients with hypertension and left atrial enlargement than that in control group and patients with hypertension without left atrium enlargement, and the differences was statistically significant. Left atrial intra-artial synchrony and inter-atrial synchrony between left atrial and right atrial gradually becomes worse in the control group, patients with hypertension without left atrial enlargement, and patients with hypertension and left atrial enlargement and there were significant differences between any two groups. P-LA, left atrial intra-atrial synchrony and inter-atrial synchrony between left atrial and right atrial were significantly correlated with hypertension. Left atrial enlargement and E/A, the relation of P-LA, left atrial intra-atrial synchrony and inter-atrial synchrony between left atrial and fight atrial to the left atrial enlargement were all best. Conclusion Left atrial intra-atrial synchrony and inter-atrial synchrony between left atrial and fight atrial in patients with hypertension without left ventricular hypertrophy are worse, with the close relationship between left atrial enlargement.