超声心动图技术对高血压患者左心室功能的研究价值
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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
Part I Evaluation of the Left Ventricular Diastolic and Systolic Function in Hypertensive Patients by Spectral Doppler and Tissue Doppler Echocardiography Imaging
Objective 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 Hypertrophy
Objective 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.
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
Part I Evaluation of the Left Ventricular Diastolic and Systolic Function in Hypertensive Patients by Spectral Doppler and Tissue Doppler Echocardiography Imaging
Objective 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 Hypertrophy
Objective 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.
引文
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4. Seccia TM, Belloni AS, Kreutz R, et al. Cardiac fibrosis occurs early and involves endothelin and AT-1 receptors in hypertension due to endogenous angiotensin Ⅱ. J Am Coll Cardiol,2003.41:666-673.
5. Berkin KE, Ball SG. Essential hypertension:the heart and hypertension. Heart,2001,86:467-475.
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7. Aeschbacher BC, Hutter D, Fuhrer J, et al. Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension. Am J Hypertens,2001, 14:106-113.
8. Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function:new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol,1988,12: 426-440.
9. Slama M, Susic D, Varagic J, et al. Diastolic dysfunction in hypertension. Curr Opin Cardiol,2002,17:368-373.
10. Lubien E, DeMaria A, Krishnaswamy P, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction:comparison with Doppler velocity recordings. Circulation,2002,105:595-601.
11. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures:A comparative simultaneous Doppler-catheterization study. Circulation,2000,102:1788-1794.
12. Mottram PM, Leano R, Marwick TH. Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function. Am J Cardiol,2003.92:1434-1438.
13. Appleton CP, Firstenberg MS, Garcia MJ, et al. The echo-Doppler evaluation of left ventricular diastolic function. A current perspective. Cardiol Clin,2000,18: 513-546, ix.
14. Waggoner AD, Bierig SM. Tissue Doppler imaging:a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function. J Am Soc Echocardiogr,2001,14:1143-1152.
15. Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol,1998,32:865-875.
16. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol,1997,30:474-480.
17. Galderisi M, Caso P, Severino S, et al. Myocardial diastolic impairment caused by left ventricular hypertrophy involves basal septum more than other walls: analysis by pulsed Doppler tissue imaging. J Hypertens,1999,17:685-693.
18. Vasan RS, Levy D. Defining diastolic heart failure:a call for standardized diagnostic criteria. Circulation,2000,101:2118-2121.
19. Courtois M, Mechem CJ, Barzilai B, et al. Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity. Circulation,1992,85:1132-1138.
20. Perreault CL, Meuse AJ, Bentivegna LA, et al. Abnormal intracellular calcium handling in acute and chronic heart failure:role in systolic and diastolic dysfunction. Eur Heart J,1990,11 Suppl C:8-21.
1. Levy D, Larson MQ Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA,1996,275:1557-1562.
2. Imbalzano E, Zito C, Carerj S, et al. Left ventricular function in hypertension:new insight by speckle tracking echocardiography. Echocardiography,2011,28:649-657.
3. Mirsky I, Parmley WW. Assessment of passive elastic stiffness forisolated heart muscle and the intact heart. Circ Res,1973,33(2):233-243
4. Jianwen Wang,Dirar S. Khoury, Yong Yue,et al. Preserved Left ventricular twist and circumferential deformation,but depressed longitudinal and radial deformation in patients with diastolic heart failure European Heart Journal,2008,29:1283-1289
5. Kukulski T, Jamal F, Herbots L, et al. Identification of acutely ischemic myocardium using ultrasonic myocardial strain measurements. A clinical study in patients undergoing coronary angioplasty J Am Coll Cardiol,2003,41(5):810-819
6. Jamal F, Kukulski T, Sutherland GR, et al. Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infraction? An ultrasonic myocardial strain rate and myocardial strain study. J Am Soc Echocardiogr,2002,15(7):723-730
7. Kukulski T, Jamal F, D'Hooge J,et al.Acute changes in systolic and diastolic events during clinical coronary angioplasty:a comparison of regional velocity, myocardial strain rate measurement.J Am Soc Echocardiogr,2002,15(1):12-21
8. Jamal F, Kukulaski T, Strotmann J,et al. Quantification of spectrum of changes in regional myocardial function during acute ischemia in closed chest pigs:an ultrasonic myocardial strain rate and myocardial strain study. J Am Soc Echocardiogr,2001,14(19):874-884
9. Leitman M, Lysyansky P, Sidenko S, et al. Tow-dimensional myocardial strain-anovel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr,2004,17(10):1021-1029
10. Breithardt OA, Stellbrink C, Herbots L, et al. Cardiac resynchronization therapy can reverse abnormal myocardial myocardial strain distribution in patients with heart failure and left bundle branch block, J Am Coll Cardial,2003,42(3):486-494
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2. Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA,1996,275:1557-1562.
3. Rossi MA. Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans. J Hypertens,1998,16: 1031-1041.
4. Seccia TM, Belloni AS, Kreutz R, et al. Cardiac fibrosis occurs early and involves endothelin and AT-1 receptors in hypertension due to endogenous angiotensin Ⅱ. J Am Coll Cardiol,2003.41:666-673.
5. Berkin KE, Ball SG. Essential hypertension:the heart and hypertension. Heart,2001,86:467-475.
6. Yu CM, Lin H, Yang H, et al. Progression of systolic abnormalities in patients with "isolated" diastolic heart failure and diastolic dysfunction. Circulation, 2002,105:1195-1201.
7. Aeschbacher BC, Hutter D, Fuhrer J, et al. Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension. Am J Hypertens,2001, 14:106-113.
8. Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function:new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol,1988,12: 426-440.
9. Slama M, Susic D, Varagic J, et al. Diastolic dysfunction in hypertension. Curr Opin Cardiol,2002,17:368-373.
10. Lubien E, DeMaria A, Krishnaswamy P, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction:comparison with Doppler velocity recordings. Circulation,2002,105:595-601.
11. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures:A comparative simultaneous Doppler-catheterization study. Circulation,2000,102:1788-1794.
12. Mottram PM, Leano R, Marwick TH. Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function. Am J Cardiol,2003.92:1434-1438.
13. Appleton CP, Firstenberg MS, Garcia MJ, et al. The echo-Doppler evaluation of left ventricular diastolic function. A current perspective. Cardiol Clin,2000,18: 513-546, ix.
14. Waggoner AD, Bierig SM. Tissue Doppler imaging:a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function. J Am Soc Echocardiogr,2001,14:1143-1152.
15. Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol,1998,32:865-875.
16. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol,1997,30:474-480.
17. Galderisi M, Caso P, Severino S, et al. Myocardial diastolic impairment caused by left ventricular hypertrophy involves basal septum more than other walls: analysis by pulsed Doppler tissue imaging. J Hypertens,1999,17:685-693.
18. Vasan RS, Levy D. Defining diastolic heart failure:a call for standardized diagnostic criteria. Circulation,2000,101:2118-2121.
19. Courtois M, Mechem CJ, Barzilai B, et al. Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity. Circulation,1992,85:1132-1138.
20. Perreault CL, Meuse AJ, Bentivegna LA, et al. Abnormal intracellular calcium handling in acute and chronic heart failure:role in systolic and diastolic dysfunction. Eur Heart J,1990,11 Suppl C:8-21.
1. Levy D, Larson MQ Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA,1996,275:1557-1562.
2. Imbalzano E, Zito C, Carerj S, et al. Left ventricular function in hypertension:new insight by speckle tracking echocardiography. Echocardiography,2011,28:649-657.
3. Mirsky I, Parmley WW. Assessment of passive elastic stiffness forisolated heart muscle and the intact heart. Circ Res,1973,33(2):233-243
4. Jianwen Wang,Dirar S. Khoury, Yong Yue,et al. Preserved Left ventricular twist and circumferential deformation,but depressed longitudinal and radial deformation in patients with diastolic heart failure European Heart Journal,2008,29:1283-1289
5. Kukulski T, Jamal F, Herbots L, et al. Identification of acutely ischemic myocardium using ultrasonic myocardial strain measurements. A clinical study in patients undergoing coronary angioplasty J Am Coll Cardiol,2003,41(5):810-819
6. Jamal F, Kukulski T, Sutherland GR, et al. Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infraction? An ultrasonic myocardial strain rate and myocardial strain study. J Am Soc Echocardiogr,2002,15(7):723-730
7. Kukulski T, Jamal F, D'Hooge J,et al.Acute changes in systolic and diastolic events during clinical coronary angioplasty:a comparison of regional velocity, myocardial strain rate measurement.J Am Soc Echocardiogr,2002,15(1):12-21
8. Jamal F, Kukulaski T, Strotmann J,et al. Quantification of spectrum of changes in regional myocardial function during acute ischemia in closed chest pigs:an ultrasonic myocardial strain rate and myocardial strain study. J Am Soc Echocardiogr,2001,14(19):874-884
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