斑点追踪成像技术评价非杓型高血压38例左心室整体功能亚临床改变

Evaluate subclinical changes of left ventricular overall function in 38 patients with non-arytenoid blood pressure by speckle tracking technique

目的探讨斑点追踪成像技术(STI)对非杓型高血压左心室整体功能亚临床改变。方法入选2019年5月至2020年4月资阳市人民医院67例诊断为原发性高血压病人,依据24 h动态血压检查结果将其分为两组,杓型高血压组(29例):夜间动脉压下降率>10%;非杓型高血压组(38例):夜间动脉压下降率≤10%。另选同期与之相匹配的健康体检者为对照组(30例)。常规超声心动图获得左心室常规参数,同时应用STI技术获得左心室整体纵向应变(GLS)、左心室整体纵向应变率(GLSR)。结果与对照组相比,杓型高血压组和非杓型高血压组舒张末室间隔厚度(IVS)[(8.5±0.9)mm比(10.8±1.1)mm比(11.9±1.2)mm]、舒张末左心室后壁厚度(LVPW)[(8.1±0.8)mm比(10.2±0.8)mm比(11.4±1.0)mm]、二尖瓣舒张早期血流速度和舒张早期室间隔和左心室侧壁峰值速度平均值(Avge’)之比(E/e’)(5.5±0.8比6.6±1.1比8.5±1.3)均增加(P<0.05);与对照组相比,杓型高血压组和非杓型高血压组Avge’[(13.7±1.2)cm/s比(11.2±1.4)cm/s比(8.5±1.3)cm/s]、GLS[(−22.8±2.5)%比(−20.3±1.4)%比(−18.5±1.4)%]、GLSR[(−1.39±0.42)S−1比(−1.23±0.26)S^(−1)比(−1.13±0.21)S^(−1)]均减低(P<0.05)。Pearson相关性分析显示夜间平均动脉压和白昼平均动脉压之差与E/e’呈正相关(r=0.30,P<0.05),与GLS(r=−0.40,P<0.05)和GLSR(r=−0.41,P<0.05)呈负相关。结论高血压可导致左心室收缩功能亚临床损害,与杓型高血压者相比,非杓型高血压者左心室收缩功能减低更明显,STI技术可为临床上血压治疗方案选择提供客观依据。

Objective To investigate the subclinical changes of speckle tracking imaging(STI)on the overall left ventricular function of non-arytenoid blood pressure.Methods A total of 67 patients with clinically diagnosed essential hypertension in Ziyang People’s Hospital from May 2019 to April 2020 were selected and assigned into two groups according to the results of 24 h dynamic blood pressure(24 h ABPM).The decrease rate of arterial pressure at night was more than 10%in the dipper hypertension group(29 cases),while that was less than or equal to 10%in the non-dipper hypertension group(38 cases).A total of 30 healthy physical examinees who matched their gender and age during the same period were selected as the control group.While conventional echocardiography was used to obtain left ventricular parameters,STI technology was used to obtain left ventricular global longitudinal strain(GLS)and left ventricular global longitudinal strain rate(GLSR)reflecting left ventricular systolic function parameters.Results Compared with the control group,end-diastolic septal thickness(IVS)[(8.5±0.9)mm vs.(10.8±1.1)mm vs.(11.9±1.2)mm],end-diastolic left ventricular posterior wall(LVPW)[(8.1±0.8)mm vs.(10.2±0.8)mm vs.(11.4±1.0)mm],and the ratio of mean values(E/e’)of mitral valve early diastolic blood flow velocity and early diastolic ventricular septal and left ventricular lateral wall peak velocities[(5.5±0.8)vs.(6.6±1.1)vs.(8.5±1.3)]in the dipper hypertension group and the non-dipper hypertension group were all increased,and the difference was statistically significant(both P<0.05);compared with the control group,the mean(Avg e’)[(13.7±1.2)cm/s vs.(11.2±1.4)cm/s vs.(8.5±1.3)cm/s],GLS[(-22.8±2.5)%vs.(-20.3±1.4)%vs.(-18.5±1.4)%],GLSR[(-1.39±0.42)S^(-1)vs.(-1.23±0.26)S^(-1)vs.(-1.13±0.21)S^(-1)]in the dipper hypertension group and the non-dipper hypertension group were all decreased,the difference was statistically significant(all P<0.05).Pearson correlation analysis showed that the difference between nocturnal arterial pressure and daytime arterial pressure was positively correlated with E/e’(r=0.30,P<0.05),and negatively correlated with GLS(r=-0.40,P<0.05)and GLSR(r=-0.41,P<0.05).Conclusions Hypertension can lead to subclinical damage of left ventricular systolic function,and the decrease of left ventricular systolic function is more obvious in patients with non-arytenoid blood pressure than those with arytenoid blood pressure.STI technology can provide objective basis for the selection of clinical blood pressure treatment.