左心室心肌应变参数预测初诊及未经治疗高血压患者射血分数保留性心力衰竭

Left ventricular myocardial strain parameters for predicting heart failure with preserved ejection fraction in newly diagnosed or untreated hypertension patients

目的观察左心室心肌应变参数用于预测初诊及未经治疗高血压患者射血分数保留性心力衰竭(HFpEF)的价值。方法纳入105例初诊或未经治疗原发性高血压伴HFpEF患者(HFpEF组)和131名健康志愿者(对照组),比较组间左心室结构、功能和心肌应变参数,包括舒张末期左心室内径(LVEDD)、收缩末期左心室内径(LVESD)、舒张末期室间隔厚度(IVSD)、舒张末期左心室后壁厚度(LVPWD)、左心室射血分数(LVEF)、二尖瓣口舒张早期血流峰值速度(E)、二尖瓣口舒张晚期血流峰值速度(A)、二尖瓣环室间隔侧舒张早期峰值速度(e')、整体纵向应变(GLS)及整体圆周应变(GCS);以相关性分析及logistic回归分析观察HFpEF的影响因素。结果组间LVEDD、IVSD、LVPWD、LVEF、GLS及GCS差异均有统计学意义(P均<0.05)。HFpEF组GLS与E、E/A、LVEF呈负相关(r=-0.287、-0.207、-0.449,P均<0.01),与年龄、LVESD呈正相关(r=0.149、0.178,P均<0.05);GCS与CAPP、IVSD、E、LVEF呈负相关(r=-0.169、-0.189、-0.219、-0.604,P均<0.05),与LVESD呈正相关(r=0.208,P<0.01)。高血压和GCS均为HFpEF的独立危险因素(P均<0.05),CAPP、IVSD和LVPWD均为独立保护因素(P均<0.05)。结论初诊及未经治疗高血压患者左心室GCS有助于预测HFpEF,而GLS与HFpEF无明显相关性。

Objective To observe the value of left ventricular myocardial strain parameters for predicting heart failure with preserved ejection fraction(HFpEF)in newly diagnosed or untreated hypertension(HP)patients.Methods Totally 105 newly diagnosed or untreated primary HP patients with HFpEF(HFpEF group)and 131 healthy volunteers(control group)were enrolled.The left ventricular structure,function and myocardial strain parameters,including left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness at end-diastole(IVSD),left ventricular posterior wall thickness at end-diastole(LVPWD),left ventricular ejection fraction(LVEF),mitral valve peak velocity of early(E)and late(A)diastolic flow,early diastolic velocity of the septal mitral annulus(e'),left ventricular global longitudinal strain(GLS)and left ventricular global circumferential strain(GCS)were measured and compared between groups.Correlation analysis and logistic regression analysis were performed to screen the impact factors of HFpEF.Results Significant differences of LVEDD,IVSD,LVPWD,LVEF,GLS and GCS were found between groups(all P<0.05).In HFpEF group,GLS was negatively correlated with E,E/A and LVEF(r=-0.287,-0.207,-0.449,all P<0.01)but positively correlated with age and LVESD(r=0.149,0.178,both P<0.05),while GCS was negatively correlated with CAPP,IVSD,E and LVEF(r=-0.169,-0.189,-0.219,-0.604,all P<0.05)but positively correlated with LVESD(r=0.208,P<0.01).HP and GCS were both independent risk factors(both P<0.05),while CAPP,IVSD and LVPWD were all independent protective factors of HFpEF(all P<0.05).Conclusion In newly diagnosed or untreated HP patients,left ventricular GCS was helpful for predicting HFpEF,while GLS was not obviously correlated with HFpEF.