320排CT对原发性高血压患者左心室舒张功能的评估

Evaluation of left ventricular diastolic function in patients with essential hypertension by 320-CT

目的:探讨320排冠状动脉CTA在高血压患者左心室舒张功能评价中的价值,及与超声心动图评价的相关性和一致性。方法:选取临床确诊为原发性高血压并行冠状动脉CTA及心脏超声检查的患者120例,按血压值将高血压组分为轻度(40例)、中度(40例)及重度(40例)三组。同时收集40例年龄、性别相匹配正常血压者为对照组。利用CT和超声分别测量并计算出二尖瓣舒张早期峰值血流速度(E)、舒张晚期峰值血流速度(A)、二尖瓣环舒张早期峰值运动速度(e’)及左心室充盈压力(E/e’)、左心房容积指数(LAVI)、左心室舒张期扩张指数(DE)、舒张末期左心房容积(LAVd)及左心室容积(LVVd)。采用ICC分析CT测量参数的观察者内和观察者间的一致性;采用配对样本t检验比较CT与超声间测量参数的差异,Pearson或Spearman相关系数分析CT、超声测量结果的相关性,Bland‑Altman检验CT、超声测量参数的一致性。分析各组间左心室舒张功能参数CT测量值的差异性和血压与诸参数相关性。结果:CT测量诸参数值观察者内和观察者间可重复性好,ICC值为0.852~0.999(P均<0.001)。LAVd、LVVd、LAVI CT测量值略高于超声测量值,但两种方法测量的DE值差异无统计学意义(P>0.05);E/A、E/e’差异无统计学意义(P均>0.05);E/A、E/e’、LAVI、和DE存在强相关性,r值分别为0.989、0.982、0.982、0.912(P均<0.001)。利用Bland-Altman观察两种方法测值的具有较好的一致性。各高血压组E/A、DE值均低于对照组(P<0.001),E/e’、LAVI值均高于对照组(P<0.001)。E/A值与血压呈负相关(r=-0.957,P<0.001);E/e’值与血压呈正相关(r=0.942,P<0.001);LAVI值与血压呈正相关(r=0.961,P<0.001);DE值与血压呈负相关(r=-0.872,P<0.001)。结论:320排冠状动脉CTA在评价原发性高血压患者左心室舒张功能方面有一定的价值,且与超声测量结果相关性及一致性好,可以在检查冠状动脉疾病的同时附带评价其左心舒张功能,为临床医生提供更多可靠的诊疗信息。

Objective:To investigate the value of 320-Row Coronary Artery CTA in the evaluation of left ventricular diastolic function in patients with hypertension,and its correlation and consistency with echocardiography.Methods:120 patients with clinically diagnosed essential hypertension who underwent coronary CT angiography and Cardiac ultrasound were included in the research group.The research group was divided into mild,moderate and severe groups according to blood pressure.40 patients with normal blood pressure matched by age and sex were collected as the control group.The CT and Ultrasound data of all participants were measured and calculated,including Peak blood flow velocity in early diastole of mitral valve,Peak blood flow velocity in late diastole of mitral valve,Peak velocity of early diastolic mitral annulus,Left ventricular filling pressure,Left atrial volume index(LAVI),Diastolic expansion index(DE),Left atrial volume(LAVd)and Left ventricular volume(LVVd).ICC was used to evaluate the intra-observer and inter-observer differences in CT derived parameters.The differences of measurements between CT and Ultrasound were compared by paired-samples t test.Pearson or Spearman correlation coefficient was used to analyze the correlation between CT and Ultrasound measurements.Agreement between measurements of two modalities was assessed by Bland-Altman analysis.The differences of left ventricular diastolic function measured by CT and the correlation between blood pressure and left ventricular diastolic function parameters were analyzed.Results:There was a good consistency in the parameters measured by CT between intra-and inter-observer(ICC was 0.852-0.999,P<0.001).CT derived LAVd,LVVd and LAVI were significantly larger compared with those obtained from Ultrasound,but there was no significant difference in DE measured by the two modalities.The E/A and E/e'measured by CT and Ultrasound were no statistical significance.The correlation coefficients of E/A,E/e’,LAVI and DE measured by CT and Ultrasound were 0.989,0.982,0.982 and 0.912,respectively(P<0.001).The good consistency of the two modalities was observed by Bland-Altman.The E/A and DE in each research group were lower than those in the control group(P<0.001).E/e'and LAVI were higher than those in the control group(P<0.001).E/A was negatively correlated with Blood Pressure(r=-0.957,P<0.001).E/e'was positively correlated with Blood Pressure(r=0.942,P<0.001).There was a positive correlation between LAVI and Blood Pressure(r=0.961,P<0.001).DE was negatively correlated with Blood Pressure(r=-0.872,P<0.001).Conclusions:320-Row Coronary Artery CTA has certain value in evaluating the left ventricular diastolic function of patients with essential hypertension,and has good correlation and consistency with the ultrasonic measurement results.It can also evaluate the left ventricular diastolic function while examining coronary artery disease,and provide more reliable diagnosis and treatment information for clinicians.