二维斑点追踪技术评价白大衣高血压患者左心房功能

Evaluation of left atrial function with two-dimensional speckle tracking echocardiography in patients with white-coat hypertension

目的采用二维斑点追踪技术评价白大衣高血压(white-coat hypertension,WCH)患者左心房功能。方法选取辽宁中医药大学附属第二医院诊断为WCH的患者59例作为WCH组,健康体检者48例作为对照组。所有受试者均进行诊室血压和动态血压测量。运用常规超声心动图评价左心室舒张和收缩功能。运用二维斑点追踪技术测量左心房储备期纵向应变及应变率(LASr,LASRr),通道期纵向应变及应变率(LAScd,LASRcd)和收缩期纵向应变及应变率(LASct,LASRct),分别评价左心房储备功能、通道功能和泵功能。结果WCH组诊室收缩压和诊室舒张压均高于对照组(t=12.34、15.36,P<0.05);而两组之间动态血压平均值差异无统计学意义(P>0.05)。WCH组Mitral e’小于对照组,而Mitral E/e’大于对照组(t=6.52、6.76、8.35、8.61,P<0.05);两组之间左心室射血分数(LVEF)差异无统计学意义(P>0.05)。WCH组LAScd和LASRct小于对照组(t=4.08、2.84,P<0.05),LASct和LASRcd大于对照组(t=4.14、6.10,P<0.05);两组之间LASr和LASRr差异无统计学意义(P>0.05)。WCH患者诊室收缩压和舒张压与LAScd和LASRct呈负相关(r=-0.21^-0.36,P<0.05),与LASRcd和LASct呈正相关(r=0.27~0.34,P<0.05)。结论WCH患者左心房通道功能减低,而左心房泵功能增强,左心房功能与诊室血压密切相关。

Objective To evaluate left atrial function in patients with white-coat hypertension(WCH)by two-dimensional speckle tracking echocardiography.Methods 59 patients with WCH diagnosed in the second affiliated hospital of Liaoning university of traditional Chinese medicine were selected as WCH group and 48 healthy individuals were selected as control group.All subjects underwent clinic blood pressure and ambulatory blood pressure measurements.Left ventricular diastolic and systolic function was assessed using conventional echocardiography.Left atrial longitudinal strain and strain rate during the reserve period(LASr,LASRr),during the the conduitperiod(LAScd,LASRcd)and during contraction period(LASct,LASRct)was measured by two-dimensional speckle tracking echocardiography.Left atrium reserve function,conduit function and pump function were evaluated respectively.Results The clinic systolic blood pressure and diastolic blood pressure in the WCH group were higher than those in the control group(t=12.34,15.36,P<0.05).There was no significant difference in the mean ambulatory blood pressure between the two groups(P>0.05).The Mitral e’of the WCH group was smaller than that of the control group,and the Mitral E/e’was greater than that of the control group(t=6.52,6.76,8.35,8.61,P<0.05).There was no significant difference in left ventricularejection fraction(LVEF)between the two groups(P>0.05).LAScd and LASRct in WCH group were smaller than control group(t=4.08,2.84,P<0.05),and LASct and LASRcd were greater than those in control group(t=4.14,6.10,P<0.05).There was no significant differences of LASr and LASRr between the two groups(P>0.05).The systolic and diastolic blood pressures of WCH patients were negatively correlated with LAScd and LASRct(r=-0.21^-0.36,P<0.05),and positively correlated with LASRcd and LASct(r=0.27~0.34,P<0.05).Conclusion The left atrial conduit function of WCH patients is reduced,while the left atrial pump function is enhanced,and the left atrial function is closely related to the clinic blood pressure.