【作者】 巴桑；

【导师】 邓又斌；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2013， 博士

【摘要】 第一部分超声心动图血流频谱多普勒及组织多普勒技术研究高血压患者左室舒张及收缩功能目的应用超声心动图血流频谱多普勒及组织多普勒技术评价高血压患者左室舒张功能及收缩功能。方法选取60名高血压患者,根据是否存在左室肥厚将其分为高血压无左室肥厚组和高血压左室肥厚组,另选取30名正常志愿者作为对照组。对三组研究对象进行常规二维超声检查,测量左室射血分数(EF)、每搏量(SV)及左室短轴缩短率(FS)。采用脉冲多普勒技术测量舒张期二尖瓣口血流速度E峰、A峰、E/A,连续多普勒测量左室等容舒张期时间(IVRT)。采用组织多普勒技术测量二尖瓣环舒张期速度Ea峰、Aa峰、Ea/Aa。结果高血压无左室肥厚组与对照组相比E峰减低,A峰增高,E/A减小,EF、FS与对照组间无明显差异；高血压左室肥厚组与对照组相比E峰减低,A峰增高,E/A减小,且EF、FS均明显小于对照组。结论高血压患者的左室舒张功能较正常人减低,舒张功能障碍在出现心肌肥厚之前即已出现；高血压心肌肥厚患者EF较正常人减低,提示同时存在收缩功能减低。超声心动图血流多普勒及组织多普勒可以较好的评价高血压患者左室功能。第二部分实时三维超声心动图斑点追踪技术测量高血压心肌肥厚患者收缩期左室心肌应变目的采用实时三维超声心动图斑点追踪技术研究原发性高血压心肌肥厚患者的收缩期左室心肌应变特点。方法采用三维超声心动图斑点追踪技术对37例原发性高血压心肌肥厚患者及27例健康志愿者进行了室壁运动分析,测量左室纵向、圆周向、径向、面积应变,比较两组间各应变参数的差异,并分析各项整体应变参数与左室射血分数(LVEF)的相关性。结果高血压心肌肥厚患者的左室整体纵向、径向和面积应变较正常对照组明显减低,左室整体圆周向应变与对照组间无明显差异。纵向、径向、圆周向应变在左室基底段、中段明显减低,圆周向应变减低仅见于基底段。左室整体纵向、圆周向、径向、面积应变与LVEF具有相关性。结论三维超声心动图斑点追踪技术可检测到高血压心肌肥厚患者左室局部心肌收缩功能的减低更多还原

【Abstract】 Part I Evaluation of the Left Ventricular Diastolic and Systolic Function in Hypertensive Patients by Spectral Doppler and Tissue Doppler Echocardiography ImagingObjective This study was undertaken to evaluate left ventricular (LV), diastolic and systolic function in hypertensive patients by spectral Doppler and tissue Doppler echocardiography imaging.Methods60hypertensive patients were divided into2groups, which are hypertension without left ventricular hypertrophy (LVH) group and hypertension with LVH group.30normal volunteers were employed as contrast group. Echocardiography were practiced in3groups, LV ejection fraction (EF), stroke volume (SV) and shortening fraction (FS) were measured. Diastolic mitral flow E, A, E/A were measured by pulsed wave Doppler, isovolumic relaxation time (IVRT) were calculated by continuous wave Doppler. Mitral annulus velocity Ea, Aa, Ea/Aa were assessed by tissue Doppler imaging.Results Compared to normal group, the hypertension without LVH group had decreased E, increased A and decreased E/A, whereas EF and FS were not significantly different with normal group. The hypertension with LVH had decreased E, increased A and decreased E/A, while EF, FS were significantly smaller than normal group.Conclusions LV diastolic function of hypertensive patients are impaired and can be present before LVH occurs. Hypertensive patients with LVH have decreased EF, implying the presence of systolic dysfunction. Spectral Doppler and tissue Doppler echocardiography imaging provide good methods to evaluate LV function in hypertensive patients. Part Ⅱ Evaluation of the Left Ventricular Strain by Real-time Three-dimensional Speckle Tracking Echocardiography in Patients with Hypertension and Myocardial HypertrophyObjective This study was undertaken to investigate left ventricular (LV) strain in patients with hypertension (HT) and myocardial hypertrophy using three-dimensional speckle tracking echocardiography.Methods Myocardial movement was analyzed in37primary HT patients with myocardial hypertrophy and27healthy volunteers. LV longitudinal, circumferential, radial and area strains were measured. The correlation between each global strain parameter and LV ejection fraction (LVEF) was analyzed.Results LV GSL, GSR and GSA of HT patients with myocardial hypertrophy were significantly lower than the contrast group, whereas GSC showed no significant difference between the two groups. Longitudinal, radial and area strains were decreased in LV basal and middle levels, while decreased circumferential strain was detected only in basal level. There were significant correlations between LVEF and GSL, GSC, GSR, GSA.Conclusions Impairment of LV regional myocardial contractility can be detected by three-dimensional speckle tracking echocardiography.更多还原