超声斑点追踪技术评估中青年隐蔽性高血压患者左心室功能
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摘要
目的用斑点追踪技术对中青年隐蔽性高血压(MH)患者的左心室功能进行评估。方法选择2016年1月至2017年6月上海瑞金医院高血压科门诊患者140例,根据诊室和动态血压分为MH组(n=70)和正常血压组(对照组,n=70),应用超声分层斑点追踪技术分析左心室分层纵向、环周、径向应变和扭转度,计算收缩期(Ts-SD)和舒张期左心室长轴达峰时间标准差(Te-SD)作为左心室收缩和舒张不同步指数,并且比较两组间各参数的差异。用多元回归分析纵向、环周应变与血压的关系。结果与对照组相比,MH组患者径向应变和扭转度差异无统计学意义,但纵向[(-20.6±2.9)%比(-23.5±2.7)%]及环周应变[(-24.4±4.2)%比(-28.7±3.6)%]降低,左心室Ts-SD[(32.2±10.6)比(20.1±14.4)ms]和Te-SD[(32.0±12.3)比(17.9±8.9)ms]显著增大(均P<0.01)。多元线性回归分析显示,在校正了年龄、性别、体表面积等因素后,诊室(β=-0.214,P=0.018)及24h舒张压(β=-0.316,P<0.001)是左心室纵向应变改变的主要影响因素,诊室舒张压(β=-0.231,P=0.012)、24h收缩压(β=-0.223,P=0.014)及24h舒张压(β=-0.291,P=0.001)是环周应变改变的主要影响因素。结论 MH患者已出现左心室局部功能异常,可采用斑点追踪技术进行评估。
Objective To assess the left ventricular(LV)function in young and middle-aged subjects with masked hypertension(MH)by speckle tracking echocardiography. Methods From January 2016 to June 2017,140 outpatients in Hypertension Department of Shanghai Ruijin Hospital were divided into masked hypertension group(MH,n=70)and normotension group(NH,n=70),according to their office blood pressure(BP)and ambulatory BP.The longitudinal strain(LS),circumferential strain(CS),radial strain(RS)and twist were analyzed by echocardiographic stratified speckle tracking technique. The standard deviations for time to peak LS in systole and diastole(Ts-SD,Te-SD)were calculated as the index of LV systolic and diastolic asynchrony. The differences of those parameters were compared between the two groups. The association of LS and CS with BP was analyzed by multiple regression analysis. Results Compared to NH group,LS[(-20.6±2.9)%vs(-23.5±2.7)%]and CS of left ventricle[(-24.4±4.2)%vs(-28.7±3.6)%]were significantly lower,and Ts-SD [(32.2±10.6)vs(20.1±14.4)ms]and Te-SD [(32.0±12.3)vs(17.9±8.9)ms]were higher in MH group. There was no significant difference in RS and twist between the two groups. After adjustment for age,sex,body surface,and other co-variables,the diastolic BP of office(β=-0.214,P=0.018)and 24-hour(β=-0.316,P<0.001)was the main influencing factor of LS. While office diastolic BP(β=-0.231,P=0.012),24-hour systolic BP(β=-0.223,P=0.014)and 24-hour diastolic BP(β=-0.291,P=0.001)were the main factors affecting CS. Conclusion The regional LV dysfunction has occurred in subjects with masked hypertension and can be assessed by speckle tracking techniques.
Objective To assess the left ventricular(LV)function in young and middle-aged subjects with masked hypertension(MH)by speckle tracking echocardiography. Methods From January 2016 to June 2017,140 outpatients in Hypertension Department of Shanghai Ruijin Hospital were divided into masked hypertension group(MH,n=70)and normotension group(NH,n=70),according to their office blood pressure(BP)and ambulatory BP.The longitudinal strain(LS),circumferential strain(CS),radial strain(RS)and twist were analyzed by echocardiographic stratified speckle tracking technique. The standard deviations for time to peak LS in systole and diastole(Ts-SD,Te-SD)were calculated as the index of LV systolic and diastolic asynchrony. The differences of those parameters were compared between the two groups. The association of LS and CS with BP was analyzed by multiple regression analysis. Results Compared to NH group,LS[(-20.6±2.9)%vs(-23.5±2.7)%]and CS of left ventricle[(-24.4±4.2)%vs(-28.7±3.6)%]were significantly lower,and Ts-SD [(32.2±10.6)vs(20.1±14.4)ms]and Te-SD [(32.0±12.3)vs(17.9±8.9)ms]were higher in MH group. There was no significant difference in RS and twist between the two groups. After adjustment for age,sex,body surface,and other co-variables,the diastolic BP of office(β=-0.214,P=0.018)and 24-hour(β=-0.316,P<0.001)was the main influencing factor of LS. While office diastolic BP(β=-0.231,P=0.012),24-hour systolic BP(β=-0.223,P=0.014)and 24-hour diastolic BP(β=-0.291,P=0.001)were the main factors affecting CS. Conclusion The regional LV dysfunction has occurred in subjects with masked hypertension and can be assessed by speckle tracking techniques.
引文
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[12]Tientcheu D,Ayers C,Das SR,et al.Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension:analysis from the Dallas heart study[J].J Am Coll Cardiol,2015,66(20):2159-2169.
[13]Cuspidi C,Negri F,Sala C,et al.Masked hypertension and echocardiographic left ventricular hypertrophy:an updated overview[J].Blood Press Monit,2012,17(1):8-13.
[14]Cusidi C,Sala C,Tadic M,et al.Untreated masked hypertension and subclinical cardiac damage:a systematic review and meta-analysis[J].Am J Hypertens,2015,28(6):806-813.
[15]Tadic M,Cuspidi C,Vukomanovic V,et al.Does masked hypertension impact left ventricular deformation?[J].J Am Soc Hypertens,2016,10(9):694-701.
[16]Camelliti P,Borg TK,Kohl P.Structural and functional characterisation of cardiac fibroblasts[J].Cardiovasc Res,2005,65(1):40-51.
[17]Kalam K,Otahal P,Marwick TH.Prognostic implications of global LV dysfunction:a systematic review and meta-analysis of global longitudinal strain and ejection fraction[J].Heart,2014,100(21):1673-1680.
[18]Marwick TH,Gilleveri TC,Aurigemma G,et al.Recommendations on the use of echocardiography in adult hypertension:a report from the European Association of Cardiovascular Imaging(EACVI)and the American Society of Echocardiography(ASE)[J].Eur Heart J Cardiovasc Imaging,2015,16(6):577-605.
[19]Kwon BJ,Lee SH,Park CS,et al.Left ventricular diastolic dyssynchrony in patients with treatment-naive hypertension and the effects of antihypertensive therapy[J].J Hypertens,2015,33(2):354-365.
[2]Booth JN 3rd,Muntner P,Diaz KM,et al.Evaluation of criteria to detect masked hypertension[J].J Clin Hypertens(Greenwich),2016,18(11):1086-1094.
[3]Palla M,Saber H,Konda S,et al.Masked hypertension and cardiovascular outcomes:an updated systematic review and meta-analysis[J].Integr Blood Press Control,2018,11:11-24.
[4]Adamu U,Schmitz F,Becker M,et al.Advanced speckle tracking echocardiography allowing a three-myocardial layer-specific analysis of deformation parameters?[J].Eur J Echocardiogr,2009,10(2):303-308.
[5]高竞生,梁欣,施继红,等.无传统危险因素人群脑血管事件的影响因素[J].中华高血压杂志,2014,22(7):656-660.
[6]Wang Y,Moss J,Thisted R.Predictors of body surface area[J].J Clin Anesth,1992,4(1):4-10.
[7]中国高血压联盟,中国医师协会高血压专业委员会血压测量与监测工作委员会,中华高血压杂志编委会.动态血压监测临床应用中国专家共识[J].中华高血压杂志,2015,23(8):727-730.
[8]O’Brien E,Parati G,Sterqiou G,et al.European Society of Hypertension position paper on ambulatory blood pressure monitoring[J].J Hypertens,2013,31(9):1731-1768.
[9]Devereux R,Koren M,de Simone G,et al.Methods for detection of left ventricular hypertrophy:application to hypertensive heart disease[J].Eur Heart J,1993,14(suppl):S8-15.
[10]Sun JP,Xu TY,Lee AP,et al.Early diastolic dyssynchrony in relation to left ventricular remodeling and function in hypertension[J].Int J Cardiol,2015,179:195-200.
[11] Hnninen MR,Niiranen TJ,Puukka PJ,et al.Target organ damage and masked hypertension in the general population:the Finn-home study[J].J Hypertens,2013,31(6):1136-1143.
[12]Tientcheu D,Ayers C,Das SR,et al.Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension:analysis from the Dallas heart study[J].J Am Coll Cardiol,2015,66(20):2159-2169.
[13]Cuspidi C,Negri F,Sala C,et al.Masked hypertension and echocardiographic left ventricular hypertrophy:an updated overview[J].Blood Press Monit,2012,17(1):8-13.
[14]Cusidi C,Sala C,Tadic M,et al.Untreated masked hypertension and subclinical cardiac damage:a systematic review and meta-analysis[J].Am J Hypertens,2015,28(6):806-813.
[15]Tadic M,Cuspidi C,Vukomanovic V,et al.Does masked hypertension impact left ventricular deformation?[J].J Am Soc Hypertens,2016,10(9):694-701.
[16]Camelliti P,Borg TK,Kohl P.Structural and functional characterisation of cardiac fibroblasts[J].Cardiovasc Res,2005,65(1):40-51.
[17]Kalam K,Otahal P,Marwick TH.Prognostic implications of global LV dysfunction:a systematic review and meta-analysis of global longitudinal strain and ejection fraction[J].Heart,2014,100(21):1673-1680.
[18]Marwick TH,Gilleveri TC,Aurigemma G,et al.Recommendations on the use of echocardiography in adult hypertension:a report from the European Association of Cardiovascular Imaging(EACVI)and the American Society of Echocardiography(ASE)[J].Eur Heart J Cardiovasc Imaging,2015,16(6):577-605.
[19]Kwon BJ,Lee SH,Park CS,et al.Left ventricular diastolic dyssynchrony in patients with treatment-naive hypertension and the effects of antihypertensive therapy[J].J Hypertens,2015,33(2):354-365.