左室不同心肌层应变评价射血分数保留的原发性高血压患者左室心肌收缩功能  

Assessment of left ventricle systolic function in primary hypertension patients with normal left ventricle ejection fraction detected by the strain of different myocardium layers

作　　者：宋瑞肖 刘增礼[2] 黄俊[3] 李尊[1] 奚静[1] SONG Rui-xiao;LIU Zeng-li;HUANG Jun;LI Zun;XI Jing(Department of Ultrasound,Wujin Hospital Affiliated with Jiangsu University,The Wujin Clinical College of Xuzhou Medical University,Changzhou Jiangsu 213017,China;Department of Nuclear Medicine,Second Affiliated Hospital of Soochow University,Suzhou Jiangsu 215004,China;Department of Echocardiography,Changzhou Second People’s Hospital Affiliated to Nanjing Medical University,Changzhou Jiangsu 213003,China)

机构地区：[1]江苏大学附属武进医院徐州医科大学武进临床学院超声科,江苏常州213017 [2]苏州大学附属第二医院核医学科,江苏苏州215004 [3]南京医科大学附属常州市第二人民医院心血管超声科,江苏常州213003

出　　处：《中国临床医学影像杂志》2020年第9期641-646,共6页Journal of China Clinic Medical Imaging

摘　　要：目的:运用二维斑点追踪成像技术通过测量心内膜下心肌、心肌中间层、心外膜下心肌应变评价左室射血分数(Left ventricle ejection fraction,LVEF)保留的原发性高血压(PHT)患者左室收缩功能。方法:收集原发性高血压患者63例及35例健康志愿者作为正常对照组(Normal),将原发性高血压分成两组,即左室壁无增厚组(NLVH)和左室壁增厚组(LVH);3组患者均行常规超声心动图检查,采集心尖四腔、三腔及两腔心切面,二尖瓣环、乳头肌及心尖水平短轴切面,应用GE Echo PAC软件测量得到三组患者左室长轴切面纵向收缩期峰值应变,以及短轴切面上周向收缩期峰值应变,纵向应变及周向应变均包括心内膜下心肌、心肌中间层、心外膜下心肌三层心肌应变;对比三组间各参数的差异。结果:收缩期峰值应变:PHT左室壁无增厚组、左室壁增厚组及正常对照组间三层纵向、周向收缩期峰值应变趋势均为:心内膜下心肌>心肌中间层>心外膜下心肌;PHT左室壁无增厚组、左室壁增厚组及正常对照组左室前壁、侧壁及后壁的纵向收缩期峰值应变的差异均具有统计学意义(P均<0.05),其变化趋势为:正常对照组>左室壁无增厚组>左室壁增厚组;PHT左室壁无增厚组、左室壁增厚组及正常对照组间中间段及心尖段中间层和心外膜下心肌周向收缩期峰值应变的差异有统计学意义(P均<0.05),其变化趋势为:左室壁无增厚组>正常对照组>左室壁增厚组;三组间基底段心外膜下心肌周向收缩期峰值应变的差异有统计学意义(P均<0.05),其变化趋势为:正常对照组>左室壁无增厚组>左室壁增厚组。结论:左室射血分数保留的原发性高血压患者,从左室壁未发生重构到左室壁重构,其纵向收缩功能明显受损,左室前壁、侧壁及后壁的纵向收缩期峰值应变能够较好的反映纵向收缩功能受损;而周向收缩功能则由相对增强到受损。不同�Objective:In order to assess left ventricle systolic function in primary hypertension patients(PHT)with normal left ventricle ejection fraction(LVEF)detected by the strain of sub-endomyocardium,middle myocardium and sub-epimyocardium.Methods:63 PHT patients with normal LVEF and 35 age-and gender-matched normal subjects were enrolled in the study.According to left ventricular hypertrophy,PHT patients were divided into two groups:non-left ventricular hypertrophy(NLVH)and left ventricular hypertrophy(LVH).All the patients were examined by conventional echocardiography,the apical four chamber,three chamber and two chamber views and short axis views of mitral annulus,papillary muscle and apex were acquired by cardiovascular ultrasound..GE Echo PAC software was used to measure the longitudinal systolic peak strain in the long-axis section and the circumferential systolic peak strain in the short-axis section.The longitudinal strain and circumferential strain included three layers of myocardial strain,i.e.the sub-endomyocardium,the middle layer of myocardium and the subepimyocardium.The differences of parameters among the three groups were compared.Results:In peak systolic longitudinal and circumferential strain among myocardial layers in PHT patients and normal subjects were:sub-endomyocardium>middle>subepimyocardium.In peak systolic longitudinal strain,there were significant differences in LV anterior wall,lateral wall and posterior wall.The sequence was:normal>PHT with NLVH>PHT with LVH.In peak systolic circumferential strain,there were significant differences in middle myocardium and sub-epimyocardium of the middle and apical level.The sequence was:PHT with NLVH>normal>PHT with LVH.Also,there was significant difference in the sub-epimyocardium of the base level among the three groups.The sequence was:normal>PHT with NLVH>PHT with LVH.Conclusion:From no left ventricular remodeling to left ventricular remodeling,the longitudinal systolic function was impaired in PHT patients while the circumferential systolic function

关 键 词：高血压 心室功能 左 超声心动描记术 多普勒 彩色 

分 类 号：R544.1[医药卫生—心血管疾病] R540.45[医药卫生—内科学]