原发性高血压患者左心室重塑指数与超声心动图提示的左心室舒张功能的关系

The relationship between left ventricular remodeling index and left ventricular diastolic function indicated by echocardiography in essential hypertensives

目的探索原发性高血压(EH)患者左心室重塑指数与超声心动图提示的左心室舒张功能的关系。方法纳入2015年6月至2017年9月就诊于福建医科大学附属第一医院干部病房门诊及住院部的研究对象607人(其中EH患者347例和正常血压者260人),所有研究对象通过超声心动图评估后分为左心室舒张功能不全(LVDD)组和左心室舒张功能正常(Non-LVDD)组,并计算左心室重塑指数=■。结果所有研究对象中,与Non-LVDD组相比,LVDD组左心室重塑指数值较小(4.55±0.71比4.89±0.78,P<0.001),二分类逐步Logistic回归分析发现,年龄、女性、高血压病史、左心室重塑指数是LVDD的影响因素(均P<0.05);EH患者中,与Non-LVDD组相比,LVDD组左心室重塑指数较小(4.47±0.72比4.68±0.68,P<0.05),二分类逐步Logistic回归分析发现,女性、年龄、吸烟及左心室重塑指数是LVDD的影响因素(均P<0.05),进一步将EH患者按性别分层分析发现,无论是男女,左心室重塑指数都是EH患者发生LVDD的影响因素(均P<0.05);将EH患者按照<50、50~<65、≥65岁3个年龄段进行分层分析,结果显示,左心室重塑指数是50~<65岁EH患者发生LVDD的影响因素(P<0.05)。EH患者行Spearman秩相关分析显示,左心室重塑指数与二尖瓣口舒张早期血流峰值速度(E)、二尖瓣环舒张早期平均峰值速度(ē)、E/二尖瓣口舒张晚期峰值速度(A)呈正相关(P<0.05),而与LAD、E/ē、A呈负相关(P<0.05),与左心室射血分数(LVEF)、左心室短轴收缩率(FS)相关性无统计学意义(P>0.05)。结论左心室重塑指数是50~<65岁EH患者发生LVDD的影响因素。

Objective To investigate the association between left ventricular remodeling index(RI)and left ventricular diastolic function indicated by echocardiography in essential hypertensives.Methods Between June 2015 to September 2017,a total of 607 subjects(347 hypertensive and 260 normotensives)were enrolled from the outpatient and inpatient departments of the cadre ward in the First Affiliated Hospital of Fujian Medical University.All the subjects were divided into left ventricular diatolic dysfunction(LVDD)group and left ventricular diatolic normal(Non-LVDD)group by echocardiography.RI was defined and calculated as the ratio of cubic root of left ventricular end diastolic volume(LVEDV)to inter-ventricular septal thickness(IVST).Results Among all subjects,RI in LVDD group was lower(4.55±0.71 vs 4.89±0.78,P<0.001)than that in Non-LVDD group.Two category stepwise Logistic regression analysis indicated that age,female,history of hypertension and RI were associated with LVDD(all P<0.05).In EH patients,RI in LVDD group was lower than that in Non-LVDD group(4.47±0.72 vs 4.68±0.68,P<0.05).The two category stepwise Logistic regression analysis also showed that female,age,smoking and RI were the influencing factors of LVDD(all P<0.05).Further stratified analysis of EH patients by gender revealed that RI was the influencing factor of LVDD in both male and female(P<0.05).According to the age groups of<50,50-<65 and>65 years old,RI was the influencing factor of LVDD in EH patients aged50-<65 years old(P<0.05),as indicated by the stratified analysis.Spearman rank correlation analysis showed that RI was positively correlated with mitral valve orifice peak early diastolic flow velocity(E),early diastolic velocity of mitral annulus peake(ē)and E/late diastolic mitral valve blood flow peak velocity(A)(P<0.05),negatively correlated with LAD,E/ēand A(P<0.05),but not significantly correlated with left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(FS)(P>0.05).Conclusion RI is a risk factor for LVDD in EH patients aged between 50 and 65 years old.