【作者】 张静秋；

【导师】 倪锐志； 顾云； 骆志玲；

【作者基本信息】 昆明医学院 ， 内科学， 2010， 硕士

【摘要】 应用常规超声心动图及应变率技术对高血压患者在不同舒张功能状态下心房结构和功能进行分析,(1)观察高血压患者不同舒张功能分级下以应变及应变率参数表达的房间隔局部心肌功能的差异以及左右心房面积指数、容积指数等心房构型指标的差异;(2)对房间隔应变率参数与左房面积指数、左房前后径、二尖瓣瓣环组织速度的比较。(3)对房间隔应变率参数与右房面积指数、右房横径及三尖瓣瓣环组织速度的比较。(4)对房间隔局部心肌功能与双心房结构重构的相关性分析,探索新的评价心房功能的指标,为临床上对高血压患者心房功能快速、准确诊断提供依据。方法选取在我院高血压患者108例,其中男56例,女52例,年龄50-65(56.1±9.6)岁。选择健康自愿者30人为对照组,男16例,女14例,年龄53-65(54.8±11.1)岁。所有入选患者均为窦性心率,经血常规、血生化、胸片、心电图及超声心动图检查等,排外其他心血管疾病及可能影响心血管系统的内分泌、代谢等疾病。依照超声心动图确定的舒张功能状态进一步分为,A组:舒张功能正常组,B组:松弛性下降组,C组:假性正常组,D组:限制性充盈组。所有入选者均在安静状态下取左侧卧位,连接心电图进行常规二维超声心动图检查、脉冲多普勒测量二尖瓣、三尖瓣血流、组织多普勒组织速度显像(TDI)动态图像采集。所有图像数据存储于光盘,以备脱机分析。超声测定参数包括左房前后径(LAD),右心房横径、室间隔厚度、左室后壁厚度、左室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、射血分数(LVEF)、二、三尖瓣口血流频谱舒张早期峰值速度(E)、舒张晚期峰值速度(A)、两者比值(E/A),左室等容舒张时间(IVRT),左右心房面积指数及组织速度成像及应变率成像参数等。结果1.高血压患者与对照组之间性别、年龄、体重、身高、心率差异无统计学意义(P＞0.05)。2.左房面积指数与容积指数相似,正常对照组与A组之间无显著性差(P＞0.05),而此两组与B、C、D组差异均有统计学意义(P＜0.05),B、C、D组各指数均高于另外二组,上述参数均较左房内径这一传统评价左房功能指标更敏感。3.以右房面积指数为评价右房构型参数可发现在高血压D组大于其他四组,且D组与对照组、高血压A组、B组比较,差异有统计学意义(P＜0.05),C组较对照组及高血压A组增大,差异有统计学意义(P＜0.05)。4.房间隔应变率/应变曲线与左室曲线方向相反。房间隔应变率各组间均为中下段大于中上段。高血压各组较正常对照组,应变率(SR)曲线低平。舒张早期的E峰峰值(Sre)在正常组与A组间虽有下降趋势,但无显著性差异(P＞0.05);在对照组、A组、B组Sra呈上升趋势,但对照组与A组间差异也无统计学意义(P＞0.05),A、B组间差异有统计学意义(P＜0.05)。组间Sre逐渐递减,A、B、C组间差异有统计学意义(P＜0.05),C、D组间无显著性差异(P＞0.05),B、C、D组Sra呈逐渐递减趋势,C、D组与B组差异有统计学意义(P＜0.05),C、D组间无显著差异(P＞0.05)。5.Se及Sa均呈下降趋势,且Sa值各组间差异有统计学意义(P＜0.05)。Se值在正常组、高血压A组与高血压B、C、D组差异有统计学意义(P＜0.05),B、C组间差异无统计学意义(P＞0.05),D组与B组间差异有统计学意义(P＜0.05),且较对照组与高血压A组有显著性差异(P＜0.01)。6.房间隔应变数值Sa、应变率数值SRe与左房面积指数均呈显著负相关。结论1.房间隔应变及应变率数值的变化发生于左室舒张功能受损之前,以Sa、Sre更为稳定、敏感。2.二尖瓣血流频谱出现E/A＞1的舒张功能“假性正常化”患者,其左房面积指数较舒张功能正常组显著增大,房间隔应变率指数SRe减低,Sa增大,可应用SRe、Sa值结合左房面指数等来判断高血压患者左室舒张功能不全,比传统的二尖瓣血流频谱E/A＜1更准确,可以避免舒张功能“假性正常”。3.房间隔的应变率参数SRe与右房面积指数进行相关性研究发现,二者存在相关性,这进一步证实高血压病晚期对右心房结构和功能有影响。更多还原

【Abstract】 ObjectiveTo explore the left and right atrial structure and functional changes in various hypertension classified by diastolic state in virtue of echocardiography and strain rate analyzing(1)To validate and compare these new indices of Strain and strain rate parameters,Left and right atrial area index,volume index in various hypertension classified by diastolic state.(2) To compare these new indices of Strain and Strain rate on the atrial septum,the left atrial area index,left atrial diameter and tissue velocity of mitral annular.(3) To compare these new indices of Strain and Strain rate on the interatrial septum,the right atrial area index,right atrial diameter and tissue velocity of tricuspid annulus.(4) To explore the relationship between Regional myocardial function of the septum and the double atrial structural remodeling in essential hypertensive(EH) patients.Methods30 healthy adults(Control Group,16 men,14 women) and 108 hypertensive patients (56 men,52 women),without other cardiac diseases and systemic disorders,were included in this study.The hypertensive patients are further divided into 4 groups based on diastolic function classification:Group A,hypertensive with normal diastolic function;Group B, hypertensive with mildly impaired diastolic function,Group C:a pseudonormal mitral inflow pattern,Group D:restrictive filling group;The echocardiographic examinations were performed with a GE Vivid7 scanner equipped.For data acquisition three complete cardiac cycles were collected and stored in a cine-loop format,pulsed Doppler Data,tissue Doppler Data,tissue velocity imaging(TDI) Data were acquired with the subjects at rest,lying in the lateral supine position.General parameters were measured:left atrial diameter(LAD),right atrial diameter, interventricular septum thickness,left ventricular posterior wall thickness,left ventricular end-diastolic volume(EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(LVEF),mitral tricuspid annular early diastole(E) and late diastole(A) inflow velocities,and the ratio(E/A),left ventricular isovolumic relaxation time(IVRT),left atrial area index and tissue velocity imaging and strain rate imaging parameters.Results1.No statistical difference was found in sex,age,weight,height and heart rate between hypertension group and control group(P＞0.05).2.It is similar that in left atrial area index and volume index,there was not significantly difference between normal control group and group A(P＞0.05),while the parameters of the two groups were significant difference(P＜0.05) with B,C,D groups;B,C,D group were higher than those other two groups.The above-mentioned parameters are more sensitive to abnormal in left atrial function than left atrial dimension index of the conventional evaluation indexes.3.Right atrial area index in C,D group was inclined to enlarge compared with normal control group and group A,significant differences was found(P＜0.05)。4.The values of srtain rate and strain in artial septum mid-inferior segment were significantly higher than those of mid-superior part.Though SRe in group A was inclined to decrease compared with control group,no difference was found(P＞0.05). In control group,group A and group B,SRa was inclined to increase,but no difference was found between normal control group and group A(P＞0.05).Group B were higher than Group A,significant differences was found(P＜0.05).SRe decreased successively gradually,the parameters of group A,group B and group C were significant difference(P＜0.05).While in group B,group C and group D,SRa was inclined to decrease,significant differences was found between group C and group B(P＜0.05). 5.Both Se and Sa decreased successively gradually,significant differences of Se was found between groups except between group B and C(P＞0.05).While,SRa increased successively gradually(P＞0.05).6.Sa,SRe of septum was positive correlative with left atrial area index(P＜0.05)。Conclusion1.The strain and strain rate of septum changed before left ventricular diastolic dysfunction,and the Sa,SRe were more stable,sensitive.Sa,SRe of septum was superior to E/A in evaluating left ventricular diastolic function in Hypertensive Patients.2.Strain and strain rate curve is a superior method for the assessment of regional myocardial function of atria septum directly and can assess the effect of hypertension on left atrial deformation and the artial founction.3.Hypertension also inevitably impact on the structure and function of right atria, but Beginning of the Restructuring about the structure and function is later than others. The results about the correlative between Sa,SRe of septal and right atrial area index were consistent with the reports.更多还原