斑点追踪技术可用于早期识别老年高血压合并肥胖患者的左室几何结构受损和收缩功能障碍  

Speckle tracking technology can be used for early identification of the impairment of left ventricular geometric structure and systolic dysfunction in elderly hypertensive patients with obesity

作　　者：李萍[1,2] 杨红宇 周林燕 康春松[2] LI Ping;YANG Hongyu;ZHOU Linyan;KANG Chunsong(Department of Medical Imaging,Shanxi Medical University,Taiyuan 030001,China;Department of Ultrasound,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China)

机构地区：[1]山西医科大学医学影像学院,山西太原030001 [2]山西医科大学第三医院,山西白求恩医院(山西医学科学院),同济山西医院超声科,山西太原030032

出　　处：《分子影像学杂志》2025年第1期37-43,共7页Journal of Molecular Imaging

基　　金：山西省重点研发计划(社会发展)项目(201903D321199)。

摘　　要：目的应用斑点追踪技术联合常规超声心动图评价肥胖对老年高血压患者左室几何构型和心肌力学的影响。方法收集2023年1~12月于山西白求恩医院就诊的原发性老年高血压患者152例,依据BMI分为正常体质量组(n=62)、超重组(n=50)、肥胖组(n=40),另收集健康对照组50例。获得常规及整体纵向应变(GLS)参数。比较各组间超声参数的差异及4种左室几何构型的发生率。结果从对照组到正常体质量组、超重组、肥胖组的GLS逐渐减小,对照组、正常体质量组、超重组、肥胖组的左室质量指数逐渐增大(P<0.05);超重组、肥胖组的离心性肥厚发生率高于对照组及正常体质量组;从对照组到正常体质量组、超重组、肥胖组的向心性肥厚发生率升高(P<0.05)。相关性分析显示,年龄、收缩压、BMI、高血压病程与GLS呈负相关;年龄、收缩压、BMI与左室质量指数呈正相关(P<0.05)。多因素线性回归分析结果显示,收缩压、BMI是GLS的影响因素;BMI是左室质量指数升高的独立危险因素。结论肥胖对高血压患者左室收缩、舒张功能障碍及左心室肥厚有叠加作用。BMI升高是左室收缩功能障碍及左心室肥厚的独立危险因素,合并肥胖更易导致左室发生向心性肥厚,由于向心性肥厚与心血管风险高、预后差相关,早期识别、干预此类患者的左室几何结构受损有助于减少高血压合并肥胖患者心血管疾病的发生。Objective To investigate the impact of obesity on left ventricular geometry and myocardial mechanics in elderly hypertensive patients using speckle tracking combined with conventional echocardiography.Methods We enrolled 152 elderly patients with primary hypertension from Shanxi Bethune Hospital between January and December 2023.Participants were categorized based on their BMI into normal weight group(n=62),overweight group(n=50),and obesity group(n=40),with an additional 50 healthy controls.Echocardiography was performed to assess conventional and global longitudinal strain(GLS)parameters.We analyzed the differences in echocardiographic parameters and the prevalence of left ventricular geometric configurations across the groups.Results GLS progressively decreased from control group to normal weight group,overweight group and obese group.Left ventricular mass index(LVMI)gradually increased from control group,normal weight group,overweight group and obese group(P<0.05).The prevalence of eccentric hypertrophy was higher in overweight and obesity groups compared to the control and normal weight groups;The prevalence of concentric hypertrophy increased gradually from the control group to the normal weight group,overweight group and obese group(all P<0.05).Correlation analysis revealed that GLS was negatively correlated with age,systolic blood pressure(SBP),BMI and duration of hypertension;LVMI was positively correlated with age,SBP and BMI(P<0.05).Multi-factor linear regression analysis identified that SBP and BMI are the factors of GLS;BMI is an independent risk factor for elevated LVMI.Conclusion Obesity exerts a synergistic effect on left ventricular systolic and diastolic dysfunction and left ventricular hypertrophy in hypertensive patients.BMI is an independent risk factor for left ventricular systolic dysfunction and left ventricular hypertrophy,with the obese condition being more likely to induce left ventricular hypertrophy,which with increased cardiovascular risk and poorer prognosis.Early detection and inte

关 键 词：高血压 肥胖 左室质量指数 几何构型 心肌力学 

分 类 号：R544.1[医药卫生—心血管疾病] R589.2[医药卫生—内科学] R540.45[医药卫生—临床医学]