应用二维斑点追踪评估高血压患者左室肥厚对右心室功能的影响  

Assessment on right ventricular function in hypertension patients with left ventricular hypertrophy by 2-dimensional speckle tracking imaging

作　　者：廖康腊[1] 曾雨薇[1] 罗素新[1] 廖慧[1] 秦俭[1] 董小燕[2] Liao Kangla Zeng Yuwei Luo Suxin Liao Hui Qin Jian Dong Xiaoyan(Department of Cardiology Department of Physical Examination,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院心内科,重庆400016 [2]重庆医科大学附属第一医院健康体检部,重庆400016

出　　处：《重庆医科大学学报》2017年第5期532-536,共5页Journal of Chongqing Medical University

摘　　要：目的:应用二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)技术定量评价原发性高血压患者左室肥厚对右心室功能的影响。方法:收集我院确诊为原发性高血压的患者共60例,将左室质量指数(left ventricular mass index,LVMI),男性≥115 g/m^2,女性≥95 g/m^2的患者分左室肥厚组(B组30例),其余为无肥厚组(A组30例)。行常规超声及二维斑点追踪检查并检测右心室功能指标,包括心室大小、左室壁厚度、左室射血分数(left ventricular ejection fraction,LVEF)、三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、右室面积变化率(right ventricular fractional area change,RVFAC)、左室全局纵向峰值收缩期应变(left ventricular global longitudinal peak systolic strain,LVGLS)及右心室游离壁及间隔的各节段纵向峰值收缩应变。结果:2组间心室大小、LVEF、TAPSE、RVFAC均无统计学差异(P>0.05)。B组室壁厚度及左室质量指数显著高于A组。B组LVGLS及右心室游离壁及间隔的各节段纵向峰值收缩应变均明显低于A组(P<0.05)。LVGLS与TAPSE、RVFAC、右心室游离壁基底段、中段、心尖段及间隔的基底段、中段、心尖段纵向峰值收缩应变呈正相关(r分别为0.606、0.333、0.379、0.289、0.384、0.500、0.515、0.317,P<0.05);LVMI与TAPSE、RVFAC无明显相关,与右心室游离壁基底段、中段、心尖段及间隔的基底段、心尖段纵向峰值收缩应变呈负相关(r分别为-0.318、-0.305、-0.328、-0.340、-0.268,P<0.05)。结论:斑点追踪可定量评价原发性高血压患者左室肥厚对右心室功能的影响,且优于常规超声。左室肥厚及左室整体功能损伤可间接影响右心室功能。Objective：To evaluate right ventricular function in primary hypertension patients with left ventricular hypertrophy by 2-dimensional speckle tracking imaging. Methods：Sixty primary hypertension patients were enrolled into this study,and divided into 2groups according to left ventricular mass index（LVMI）：left ventricular hypertrophy（group B,n=30）,without left ventricular hypertrophy（group A,n=30）. Echocardiographic parameters were measured,including ventricular size,left ventricular thickness,left ventricular ejection fraction（LVEF）,tricuspid annular plane systolic excursion（TAPSE）,right ventricular fractional area change（RVFAC）,left ventricular global longitudinal peak systolic strain（LVGLS） and right ventricular each segment longitudinal peak systolic strain.Results：No significance was observed between groups in ventricular diameters,LVEF,TAPSE,RVFAC（P〈0.05）. The wall thickness and LVMI of group B were significantly higher than those of group A（P〈0.05）. LVGLS and right ventricular each segment longitudinal peak systolic strain of group B were significantly lower than those of group A（P〈0.05）. LVGLS with TAPSE,RVFAC,right ventricular each segment（RVLSbas,RVLSmid,RVLSapi,IVSLSbas,IVSLSmid,IVSLSapi）longitudinal peak systolic strain were positively correlated（r：0.606,0.333,0.379,0.289,0.384,0.500,0.515,0.317;P〈0.05）. LVMI and right ventricular each segment（RVLSbas,RVLSmid,RVLSapi,IVSLSbas,IVSLSapi）longitudinal peak systolic strain were negatively correlated（r：-0.318,-0.305,-0.328,-0.340,-0.268;P〈0.05）,while there was no correlation between TAPSE and RVFAC. Conclusion：2D-STI can quantitatively evaluate right ventricular function in primary hypertension patients with left ventricular hypertrophy,and is superior to traditional echo parameters. Left ventricular hypertrophy and left ventricular global function damage can indirectly affect right ventricular function.

关 键 词：斑点追踪显像技术 高血压 左室肥厚 右心室功能 

分 类 号：R541.3[医药卫生—心血管疾病]