实时三维超声心动图评价原发性高血压病左室不同构型患者的右室结构及功能

Evaluation on the right ventricular structure and function in essential hypertension patients with different left ventricular geometry by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图(RT-3DE)在评价原发性高血压病左室不同构型患者右室早期结构及功能变化中的价值。方法选取113例原发性高血压病患者,先行二维超声心动图(2DE)检查获得三尖瓣脉冲多普勒频谱舒张早、晚期峰值速度的比值(E/A)、三尖瓣脉冲多普勒频谱舒张早期峰值速度与三尖瓣环组织多普勒频谱舒张早期峰值速度的比值(E/e’)、右室Tei指数、三尖瓣环收缩期位移(TAPSE)及右室收缩压(SPAP),然后行RT-3DE检查获得右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室射血分数(RVEF)及右室每搏量(RVSV)。根据左室质量指数(LVMI)和相对室壁厚度(RWT),将113例患者分为正常构型组47例、向心性重构组29例、离心性肥厚组14例、向心性肥厚组23例,比较各组结构和功能参数。结果①与向心性肥厚组比较,离心性肥厚组的RVSV和右室内径均明显增大,RVEF明显减低(均P<0.05);与正常构型组、向心性重构组和离心性肥厚组比较,向心性肥厚组的Tei指数、SPAP、RVFW显著增加,TAPSE明显减低(均P<0.05);②与正常构型组、向心性重构组和离心性肥厚组比较,向心性肥厚组E/A明显减小,E/e’明显增加(均P<0.05);③与正常构型组和向心性重构组比较,离心性肥厚组和向心性肥厚组的RVEDV和RVESV均明显增高(均P<0.05);RVEF从正常构型组到向心性肥厚组依次减低,与正常构型组比较,向心性肥厚组的RVEF明显减低(P<0.05)。结论原发性高血压病左室不同构型患者的右室结构和功能不同,以向心性肥厚患者右室结构和功能受损最重;RT-3DE能较准确地评价高血压病患者右室结构及功能的变化,有较好的临床应用价值。

Objective To evaluate the right ventricular structure and function in essential hypertension patients with different left ventricular geometry by real-time three-dimensional echocardiography(RT-3DE).Methods A total of 113 subjects with essential hypertension were enrolled in this study.Two-dimensional echocardiography(2DE)was performed to obtain tricuspid annulus E/A and E/e’,right ventricular Tei index,tricuspid annulus systolic displacement(TAPSE)and right ventricular systolic pressure(SPAP),then RT-3DE was performed to obtain right ventricular end diastole volume(RVEDV),right ventricular end systole volume(RVESV),right ventricular ejection fraction(RVEF)and right ventricular stroke volume(RVSV).According to left ventricular mass index(LVMI)and relative wall thickness(RWT),113 patients were divided into normal configuration group(47 cases),concentric remodeling group(29 cases),eccentric hypertrophy group(14 cases)and concentric hypertrophy group(23 cases).The structural and functional parameters of each group were compared.Results①Compared with concentric hypertrophy group,RVSV and right ventricular diameter in eccentric hypertrophy group were significantly increased,and RVEF was significantly decreased(all P<0.05).Compared with normal configuration group,concentric remodeling group and eccentric hypertrophy group,Tei index,SPAP,RVFW in concentric hypertrophy group increased significantly,while TAPSE decreased significantly(all P<0.05).②Compared with normal configuration group,concentric remodeling and eccentric hypertrophy groups,E/A was significantly decreased,and E/e’was significantly increased in concentric hypertrophy group(all P<0.05).③Compared with normal configuration group and concentric remodeling group,RVEDV and RVESV in eccentric hypertrophy group and concentric hypertrophy group were significantly higher(all P<0.05).RVEF decreased from normal configuration group to concentric hypertrophy group.Compared with normal configuration group,RVEF in concentric hypertrophy group decreased significantly(P<0.05).Conclusion The structure and function of right ventricle on the basis of different geometry of left ventricle in patients with essential hypertension are different,especially in concentric hypertrophy patients.RT-3DE can accurately evaluate the changes of right ventricular structure and function in hypertensive patients,which is helpful for early diagnosis and evaluation on therapeutic effect.