室壁中层缩短率评价不同类型昼夜节律高血压患者早期左心室收缩功能的价值

Evaluation of left ventricular systolic function in patients with different types of circadian rhythm hypertension by ventricular wall medial shortening

目的研究心脏结构与射血分数(EF)均正常的轻中度原发性高血压患者的左室中层缩短率(MFS)在不同血压昼夜节律变化模式中与早期左室收缩功能受损的相关性,以进一步了解血压昼夜节律变化与心脏靶器官损害的关系。方法选择血压控制良好的心脏结构与EF正常的高血压患者193例,根据血压昼夜节律划分为深杓型组45例,杓型组47例,非杓型组53例和反杓型组48例,超声检测心功能,分别测量收缩和舒张功能指标,分析收缩功能指标EF、短轴缩短率(FS)、MFS之间的相关性及MFS与血压昼夜节律和临床各项指标之间的关系。结果深杓型、杓型组、非杓型组和反杓型组4组间一般情况、平均血压、左室重量指数、降压药物使用间差异无统计学意义。关于舒张功能E/E’等指标,反杓型组、非杓型组均明显高于杓型和深杓型组,差异有统计学意义(P <0.05)。常规检测的心脏收缩功能指标左心室射血分数EF、左室短轴缩短率FS 4组间比较,差异无统计学意义(P> 0.05),且均在正常范围,但4组MFS均低于正常对照组MFS预测值95%的可信区间,有统计学差异,其中非杓型组和反杓型组明显低于深杓型组和杓型组(P <0.05)。MFS与其他超声评价指标中收缩功能指标均有相关性,而与舒张功能指标均不相关。结论高血压患者心脏早期收缩功能障碍与血压昼夜节律异常模式密切相关。收缩功能参数中室壁中层缩短率MFS是相对独立于负荷指标的早期评估亚临床收缩功能障碍的敏感参数,能早期发现无症状高血压患者心功能的异常及异常的程度,收缩功能损害从深杓型、杓型、到非杓型组、反杓型组逐渐加重。

Objective To investigate the relationship between left ventricular middle fractional shotening(MFS) and early left ventricular systolic dysfunction in patients with mild to moderate essential hypertension with normal cardiac structure and ejection fraction( EF) in different circadian patterns of blood pressure. To further understand the relationship between the circadian rhythm of blood pressure and cardiac target organ damage. Methods Hypertensive patients with well-controlled heart structure and EF normal ejection fraction(EF) were selected. According to the circadian rhythm of blood pressure, patients(n = 193) were divided into deep dipper group(n = 45), dipper group(n = 47), non-dipper group( n = 53) and anti-dipper group(n = 48). The systolic and diastolic function indexes were measured by echocardiography, and the correlation among the systolic function index(EF/FS/MFS) and the circadian rhythm of blood pressure and clinical indexes were analyzed. Results There was no significant difference in average blood pressure, left ventricular mass index and antihypertensive drug use among the four groups. The diastolic function E/E’ in anti-dipper group and non-dipper group were significantly higher than those in dipper and deep dipper group(P < 0.05). There was no significant difference among the four groups(P > 0.05), but the MFS of the four groups was lower than that of the normal control group(95% confidence interval). There was significant difference between non-dipper group and anti-dipper group, which was significantly lower than that of deep dipper group and dipper type group(P < 0.05). The correlation between MFS and other indexes of cardiac echocardiography was also compared. The results showed that MFS was correlated with systolic index but not with diastolic function index. Conclusions The early systolic dysfunction in hypertensive patients is closely related to the abnormal ciradian rhythm of blood pressure. MFS is a sensitive parameter for the early assessment of subclinical systolic dysfunction,which is relatively independent of the load index. The abnormal cardiac function and the degree of abnormal cardiac function in asymptomatic hypertension patients could be found early. The impairment of systolic function was gradually aggravated from deep dipper type to non-dipper type and anti-dipper type group.