二维及三维纵向应变评价高血压对未用药物治疗的中年患者左室心肌功能的早期影响

Two-dimensional and three-dimensional longitudinal strain in evaluation of early effect of hypertension on left ventricular systolic function in middle-aged patients without medication

目的:应用二维(2D-STE)及三维斑点追踪成像技术(3D-STE)中的整体纵向应变(LS)指标评价原发性高血压患者早期左室心肌收缩功能的改变,探讨3D-STE的应用价值及优越性。方法:采用45~65岁为中年人群年龄范围,高血压组收集未经治疗的原发性高血压患者34例,对照组收集年龄、性别相匹配的健康志愿者34例。常规测量室间隔厚度(IVSTd)、左室后壁厚度(LVPWTd)、相对室壁厚度(RWT)、二维左室射血分数(2D-EF);应用2D-STE测量左室整体纵向应变(2D-LS);利用3D-STE获取左室射血分数(3D-EF)、左室心肌质量指数(LVMi)及3D-LS。结果:两组间IVSTd、LVPWTd、RWT、2D-EF、3D-EF、2D-LS均无统计学差异(P>0.05);高血压组3D-LS低于对照组,LVMi高于对照组,且差异均有统计学意义(P<0.05)。3D-LS绝对值与3D-EF呈正相关(r=0.28,P<0.05),与SBP及DBP均呈负相关(r=-0.39,P<0.05;r=-0.31,P<0.05)。结论:中年原发性高血压患者,早期左室尚未发生重构时,左室心肌收缩功能已经减低,3D-LS较2D-LS能更敏感地检测出中年原发性高血压患者早期左室心肌收缩功能的减低,具有良好的临床应用前景。

Objective:To evaluate the changes of left ventricular(LV)systolic function in patients with essential hypertension in early stage by using the longitudinal strain(LS)index of two-dimension(2D)and three-dimensional speckle-tracking echocardiography(3D-STE),and to explore the application value and superiority of 3D-STE.Methods:Thirty-four cases of untreated essential hypertension were collected from 45~65 years old middle-aged people in the hypertension group(H)and 34 healthy volunteers matched in age and sex were collected in the control group(C).Left ventricular posterior wall thickness at end-diastole(LVPWTd),interventricular septal thickness at end-diastole(IVSTd),relative wall thickness(RWT),and left ventricular ejection fraction(2D-EF)were measured.2D-LS was calculated by 2D-STE.3D-EF,LV mass index(LVMi),and 3D-LS were calculated by 3D-STE.Results:There was no significant difference in LVPWTd,IVSTd,RWT,2D-LS,2D-EF and 3D-EF;3D-LS was significantly lower(P<0.05)and LVMi was significantly higher(P<0.05)in H than that in C.3D-LS was positively correlated with 3D-EF(r=0.28,P<0.05),and negatively correlated with SBP,DBP(r=-0.39,P<0.05;r=-0.31,P<0.05).Conclusion:In the middle-aged patients with essential hypertension,the left ventricular systolic function has been reduced when the early left ventricle has not been reconstructed.3D-LS is more sensitive than 2D-LS to evaluate the left ventricular systolic function in the early stage of hypertension.