应变结合峰值离散度评价保留射血分数高血压病人左心室收缩功能的研究

Assessment of left ventricular systolic function in hypertensive patients with preserved ejection fraction by strain and peak dispersion

目的:采用二维斑点追踪技术(2D-STI)评价原发性高血压病人左心室功能。方法:选取左心室射血分数(LVEF)>52%的原发性高血压病人50例作为高血压组,根据左心室质量指数(LVMI)分为左心室肥厚组(LVH组)和非左心室肥厚组(NLVH组),同时选取健康体检者22名作为对照组。经常规二维超声心动图获得常规超声数据,2D-STI获取左心室整体纵向峰值应变(GLS)、整体环周峰值应变(GCS)、整体径向峰值应变(GRS)、左室总旋转角度(LVtor)、纵向应变达峰时间离散度(LPSD)及环周应变达峰时间离散度(CPSD),比较各组间上述参数并与LVMI进行相关性分析。结果:3组整体径向峰值应变间差异无统计学意义(P>0.05);LVH组GLS均明显低于NLVH组和对照组(P<0.01),NLVH组GLS明显低于对照组(P<0.01);LVH组GCS、LVtor、LPSD、CPSD均明显高于NLVH组和对照组,NLVH组GCS、LVtor、LPSD亦均明显高于对照组(P<0.01)。Pearson相关分析显示,LVMI与GLS呈负相关关系(P<0.01),与GCS、LVtor、LPSD、CPSD均呈正相关关系(P<0.01)。结论:保留型射血分数的高血压病人左心室收缩功能已经受损,而随着左心室收缩功能受损加重,GLS、GCS、LVtor、LPSD可作为评价原发性高血压病人早期左心室收缩功能改变的可靠指标,为临床诊断和疗效评估提供帮助。

Objective:To evaluate left ventricular function in patients with essential hypertension by two-dimensional speckle tracking imaging(2D-STI).Methods:Fifty essential hypertension patients with left ventricular ejection fraction(LVEF)>52%were selected as the hypertension group,and according to left ventricular mass index(LVMI),they were divided into left ventricular hypertrophy group(LVH group)and non-left ventricular hypertrophy group(NLVH group).Twenty-two healthy subjects were selected as the control group.Conventional ultrasound data were obtained by conventional two-dimensional echocardiography.Global peak longitudinal strain(GLS),global peak circumferential strain(GCS),global peak radial strain(GRS),left ventricular total rotation Angle(LVtor),longitudinal strain peak time dispersion(LPSD)and circumferential strain peak time dispersion(CPSD)were measured by 2D-STI.The above parameters were compared among groups and their correlation with LVMI was analyzed.Results:There were significant differences in GLS,GCS,LVtor and LPSD among groups(P<0.05).CPSD:there were significant differences between control group and LVH group,NLVH group and LVH group(P<0.05).GLS was negatively correlated with LVMI(P<0.01),GCS,LVtor and LPSD were positively correlated with LVMI(P<0.01),and CPSD was weakly positively correlated with LVMI(P<0.01).Conclusions:Left ventricular systolic function is impaired in essential hypertension patients with preserved ejection fraction,and the damage of left ventricular systolic function is aggravated with the thickening of left ventricular systolic function.GLS,GCS,LVtor and LPSD can be used as reliable indicators to evaluate the early changes of left ventricular systolic function in essential hypertension patients,and provide help for clinical diagnosis and efficacy evaluation.