左心室心肌做功参数评估原发性高血压患者左心室功能

Left ventricular myocardial work parameters for evaluating left ventricular function in patients with essential hypertension

目的观察左心室心肌做功(LVMW)参数评估原发性高血压(EHT)患者左心室功能的价值。方法选取102例EHT患者,按高血压分级分为EHT 1级组(n=39)、EHT 2级组(n=30)及EHT 3级组(n=33);以36名健康成年志愿者作为对照组。对比各组常规超声心动图参数、纵向峰值应变离散度(PSD)、整体纵向应变(GLS)及LVMW参数,包括整体做功效率(GWE)、整体做功指数(GWI)、整体有用功(GCW)及整体无用功(GWW);观察LVMW参数与常规超声心动图参数、PSD及GLS的相关性;分析LVMW参数评估左心室功能的价值。结果4组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔舒张末期厚度(IVSD)、左心室后壁舒张末期厚度(LVPWD)、左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A)、E/A、二尖瓣环舒张早期侧壁运动速度(e'侧壁)、室间隔运动速度(e'室间隔)、室间隔收缩期运动速度(s'室间隔),E与e'侧壁和e'室间隔均值的比值(E/e')、收缩压及舒张压差异均有统计学意义(P均<0.05)。EHT 2、3级组与对照组之间GWE、GWI及GCW差异有统计学意义(P均<0.05);且EHT 1、2及3级组间两两比较,GWI和GCW差异均有统计学意义(P均<0.05)。EHT 1、2、3级组与对照组比较GWW、GLS及PSD差异均有统计学意义(P均<0.05),而EHT 1、2及3级组间两两比较差异均无统计学意义(P均>0.05)。GWE与PSD、GLS及EDV呈负相关(β均<0,P均<0.05),与E/A呈正相关(β>0,P<0.05);GWI与GLS呈负相关(β<0,P<0.05),与E/e'、收缩压及舒张压呈正相关(β均>0,P均<0.05);GCW与GLS呈负相关(β<0,P<0.05),与E/e'、收缩压及舒张压呈正相关(β均>0,P均<0.05);GWW与PSD及收缩压均呈正相关(β均>0,P均<0.05)。结论LVMW参数,尤其GWI及GCW,可定量评估不同分级EHT患者左心室功能。

Objective To observe the value of left ventricular myocardial work(LVMW)parameters for evaluating left ventricular function in patients with essential hypertension(EHT).Methods Totally 102 patients with EHT were enrolled and divided into EHT grade 1 group(n=39),EHT grade 2 group(n=30)and EHT grade 3 group(n=33)according to blood pressure,while 36 healthy adult volunteers were recruited as control group.Conventional echocardiographic parameters,longitudinal peak strain dispersion(PSD),global longitudinal strain(GLS)and LVMW parameters were compared among 4 groups,including global work efficiency(GWE),global work index(GWI),global constructive work(GCW)and global wasted work(GWW).The correlations of LVMW parameters and conventional echocardiographic parameters,PSD and GLS were observed.The value of LVMW parameters for evaluating left ventricular function were analyzed.Results There were significant differences of left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septum thickness at end-diastole(IVSD),left ventricular posterior wall thickness at end-diastole(LVPWD),end-diastolic volume(EDV),end-systolic volume(ESV),early diastolic blood flow velocity(E)and late diastolic blood flow velocity(A)of mitral orifice,E/A,early diastolic mitral annulus lateral wall(e'lateral)and ventricular septal velocity(e'septal),systolic ventricular septal velocity(s'septal),ratio of E to mean value of e'lateral and e'septal(E/e'),also systolic and diastolic blood pressure(all P<0.05).There were significant differences of GWE,GWI and GCW between EHT grade 2 or grade 3 groups and control group(all P<0.05),and pairwise comparison showed that there were significant differences of GWI and GCW of EHT grade 1,2 and 3 groups(all P<0.05).There were significant differences of GWW,GLS and PSD between EHT grade 1,2,3 groups and control group(all P<0.05),while pairwise comparison showed that there was no significant difference among grade 1,2 and 3 groups(all P>0.05).GWE was negatively correlated with PSD,GLS and EDV(allβ<0,all P<0.05),but positively correlated with E/A(β>0,P<0.05).GWI was negatively correlated with GLS(β<0,P<0.05),but positively correlated with E/e',systolic and diastolic blood pressure(allβ>0,all P<0.05).GCW was negatively correlated with GLS(β<0,P<0.05),positively correlated with E/e',systolic and diastolic blood pressure(allβ>0,all P<0.05).GWW was positively correlated with PSD and systolic blood pressure(bothβ>0,both P<0.05).Conclusion LVMW parameters,especially GWI and GCW,could be used to quantitatively evaluate left ventricular function in patients with different grades of EHT.