DTI评价原发性高血压右室舒张功能
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摘要
前言
原发性高血压病是人类常见的疾病之一，不仅人群患病率高，而且可引起心脏、脑血管、肾脏等重要器官的严重损害。多年来，原发性高血压对心脏功能的影响已有许多报道，主要是关于左室的，对右室功能的变化研究相对较少，但右室在维持循环方面亦具有很重要的作用。因此，找到一个较好的测量右室功能的方法是非常必要的和有意义的。
多普勒组织成像(DTI Doppler tissue imaging)技术是一种较新的超声检查方法。该技术是运用低通滤波器删除血流信号，将组织的高振幅、低速度的回波信号进行处理，以二维彩色图像或频谱曲线形式将心脏运动的信息实事地显示出来。用DTI测量右室功能，具有以下优点：不用描画右室心内膜，由于右室内梳状肌较多很难精确描画右室心内膜；不用计算右室容量，由于右室腔形状复杂很难用一个固定而准确的数学模型来计算右室容量。因此使用DTI方法测量的结果具有很高的可信性及重复性。
实验材料与方法
研究对象：本研究包括正常对照组20例(男女各10例，年龄29～68岁，平均53.77±5.69岁)。病例组60例，按照Gannu分类方法，以其左室重量指数(LVMI)和相对室壁厚度(RWT)分为四组，正常左室构型组(Ⅰ组)：14例，男9例，女5例，年龄55.35±10.44岁；向心性重构组(Ⅱ组)：13例，男6例，女7例，年龄50.8±11.12岁；向心性肥厚组(Ⅲ组)：18例，男10例，女8例，年龄56.65±13.45岁；离心性肥厚组(Ⅳ组)：15例，男7例，女8
例，年龄61．3d4．07岁。有糖尿病、风心病、心律失常、肺高压或
肺心病等患者均不作为本研究对象。
仪器方法：采用HPSonos5500型彩色多普勒超声诊断仪，配备
DTI软件，探头频率2－4MHZ。受检者左侧卧位，联接心电图同步
监测，二维超声心动图取胸骨旁左室长轴切面，测量主动脉
（AO入左房（LAX左室舒张期内径（LVDed）及室间隔OVSthX左
后壁厚度（LVPWth人于心尖四腔及右室两腔切面上，以 Dll模
式显示三尖瓣隔叶、前叶及后叶。将脉冲多普勒取样容积分别置
于前叶、隔叶和后叶的瓣环处，取样线与瓣环处夹角控制在30”
内，滤波设置为100HZ，取得此处速度频谱，分别测量此三处舒张
早期、舒张晚期的速度峰值及等容舒张时间，取3－5个心动周期
的平均值为该处运动速度值及等容舒张时间，再以三叶瓣环的平
均值为各组的平均Ea人a＊VRT，同时计算Ea／Aa。
左室重量指数：LVMI（／m勺二LVM（左室重量）／BSA（体表面积）
LVM（g）二0．8 XI．e X ［（WSth＋LVPWth＋LVDed）3－
LyDed3］＋0．6
相对室壁厚度：RWT二0VSth＋LVPWth＊LVDed
正常值：wm：男＜＊1砂＜＼女＜106吵m＼＊WT＜0．M
正常左室构型组：LVMI及RWT均在正常范围内。
向心性重构组：RWT超过正常范围，LVMI在正常范围内。
向心性肥厚组：LVMI及RW’I’均超过正常范围。
离心性肥厚组：LVMI超过正常范围8WT在正常范围内。
统计处理：应用SPSS10．0统计软件。测量与计算结果用均值
士标准差表示，使用非配对资料的t检验，P＜o．05为差异有显著
意义。
实验结果【
1．对照组与原发性高血压各组常规超声参数比较
·2·
五组研究对象间的年龄、性别无显著差别。从左室重量指数
和相对室壁厚度两指标来看，皿 ＊组的心脏重量明显增加，皿组
的相对室壁厚度最厚J组的相对室壁厚度变薄。同对照组相比，
在原发性高血压各组中＊组的右心房形态变化较其它三组明显。
2．对照组与原发性高血压各组Di参数比较
与对照组相比，原发性高血压各组的平均EatAa值均小于1，
各组的平均ES值也显著减低汀＜0．of人各组平均IVRT均增
加，呈递增趋势（0．102，0．119，0．132，0．137），11、皿J组与对照
组比较有显著差异P＜o．01入但1组无意义；各组平均Aa均高
于对照组，也表现为递增趋势（12．44，12．74，14．18，14．2），但只有
皿J组有显著意义瞩＜o．05八原发性高血压各组三尖瓣前、
后叶瓣环的 Ea／Aa值均小于儿 IJ及皿组隔叶的 Ea／Aa值也小
于1。
讨 论
右室在维持循环方面具有很重要的作用，右室功能对临床病
人的许多问题如治疗方法、预后等是非常重要的。右心功能受损
及随之引起的一系列的病理生理改变，在一定条件下，可引起急慢
性冠状动脉病变和瓣膜心脏病。此外，右心功能受损对左心功能
不全病人的生存率有很大的影响，对先天性心脏病病人（手术治
疗和未做手术）的存活率也有影响。POlak等研究报道，冠心病伴
心衰患者，右心射血分数高的患者两年生存率明显高于射血分数
低的。右室功能受损同败血症休克有关。Fuster等报道，右室功
能对法鲁氏四联征术后长期效果有很重要的影响。右室腔形态复
杂难，测量左室的公式和模型不适用于右室，因此找到一个较好的
测量右室功能的方法是非常必要的和有意义的。DTI是一种新的
超声技术，其对右心功能的测定不需通过描绘右心腔
Preface
Essential hypertension is one of the mankind's common diseases, not merely incidence rate in population is high, and can cause the serious harm of important organs, such as blood vessel, heart, brain, kidney, etc. For many years, there are a lot of reports about essential hypertension impair function of heart, It is mainly about the left ventricular function, the change of the right ventricular function is relatively less in research, But the right ventricular function has very important in maintaining circulation. So, it is a very essential and meaningful to find a better measurement right ventricular function method. Doppler tissue imaging is a newer ultrasonic inspection method. This technology is to use the low open wave filter to delete the blood flow signal, deal with the return waves echo signal of high amplitude, low speed organized, Show heart message practical thing of sport that comes out in the form of two - dimentional colored picture or the frequency spectrum curve. Use DTI measurement right ventricular function, have the following merits; Neednt draw right ventricular membrane in the heart, because it is very difficult to draw right ventricular membrane accurate; Neednt calculate right room capacity, because of right ventricle's form that without accurate mathematics model come and calculate right ventricular capacity. So it measure result have high credibility and repetitiveness.
Material and method
Research object: normal contrast group of 20 subjects ( males 10,females 10,age 29-68 years, 53.77+5. 69 years). Case group of 60 patients, classify method according to Gannu, and relative wall thickness ( RWT) divide into four groups with left ventricular weight index ( LVMI) , Normal left ventricular construct group( I group): males 9, females 5, age 55. 35+10.44 years; centripetal reconstruct group ( II group) : males 6, females 7, Age 50. 8+11.12 years; concentric hypertrophy group(III group) : males 10, females 8, Age 56. 65+13. 45 years; eccentric hypertrophy group( IVgroup) : males 7, females 8, Age 61. 3+14. 07 years. These patients that diabetes, rheumatic mitral valve, arrhythmia, pulmonary hypertension were exclude.
Ultrasonic examination: Both patients and control subjects underwent conventional two-dimensional echocardiography with the instrument of HPSonos with a 2 - 4MHz phased array transducer and DTI software with the patients in the left lateral decubitus position. In each patients, parasternal long axis view were taken to detect the AO, LA, LVDed, IVSth, LVPWth. Then the DTI was activated at apical four -chamber and right ventricular two - chamber view to detect peak velocity and IVRT of TV at early and late term of diastole by pulse Doppler. Making averages of 3 - 5 cardiac cycle as its values, then make averages of tricuspid annulus as average Ea,Aa,IVRT of each group and calculate Ea/Aa at same time. Left ventricular muscle index: LVMI(g/m2) =LVM(left ventricular muscle )/BSA ( body surface area) ,LVM(g) =0. 8 + 1. 04 + [ (IVSth + LVPWth + LVDed)3
- LVDed3 ] + 0. 6, relative wall thickness RWT = ( IVSth + LVP-Wth)/LVDed, normal value; LVMI: males < 111g/m2, females < 106g/m2, RWT< 0.44, I group: LVMI and RWT are in the normal range, H group: RWT exceeds normal range, LVMI is in the normal range, IIIgroup: LVMI and RWT exceed the normal range, IVgroup: LVMI exceeds the normal range, RWT is in the normal range.
Statistical analysis; all data acquired was analyzed using SPSS 10.0 software. P <0.05 has remarkable meanings for the difference.
Results
These parameters were contrast of contrast group and essential hypertension group; There are not difference about age and sex of five group subjects, LVM is obviously increases of M , IV group. RWT of III group is the thickest, RWT of IV group is thin. Compared with contrast group, the size of right atrium was changed obviously in IVgroup.
average Ea/Aa values of essential hypertension every group is smaller than 1, average Ea values of every group is decreased ( P, < 0. 01) ; Every group IVRT show a
原发性高血压病是人类常见的疾病之一，不仅人群患病率高，而且可引起心脏、脑血管、肾脏等重要器官的严重损害。多年来，原发性高血压对心脏功能的影响已有许多报道，主要是关于左室的，对右室功能的变化研究相对较少，但右室在维持循环方面亦具有很重要的作用。因此，找到一个较好的测量右室功能的方法是非常必要的和有意义的。
多普勒组织成像(DTI Doppler tissue imaging)技术是一种较新的超声检查方法。该技术是运用低通滤波器删除血流信号，将组织的高振幅、低速度的回波信号进行处理，以二维彩色图像或频谱曲线形式将心脏运动的信息实事地显示出来。用DTI测量右室功能，具有以下优点：不用描画右室心内膜，由于右室内梳状肌较多很难精确描画右室心内膜；不用计算右室容量，由于右室腔形状复杂很难用一个固定而准确的数学模型来计算右室容量。因此使用DTI方法测量的结果具有很高的可信性及重复性。
实验材料与方法
研究对象：本研究包括正常对照组20例(男女各10例，年龄29～68岁，平均53.77±5.69岁)。病例组60例，按照Gannu分类方法，以其左室重量指数(LVMI)和相对室壁厚度(RWT)分为四组，正常左室构型组(Ⅰ组)：14例，男9例，女5例，年龄55.35±10.44岁；向心性重构组(Ⅱ组)：13例，男6例，女7例，年龄50.8±11.12岁；向心性肥厚组(Ⅲ组)：18例，男10例，女8例，年龄56.65±13.45岁；离心性肥厚组(Ⅳ组)：15例，男7例，女8
例，年龄61．3d4．07岁。有糖尿病、风心病、心律失常、肺高压或
肺心病等患者均不作为本研究对象。
仪器方法：采用HPSonos5500型彩色多普勒超声诊断仪，配备
DTI软件，探头频率2－4MHZ。受检者左侧卧位，联接心电图同步
监测，二维超声心动图取胸骨旁左室长轴切面，测量主动脉
（AO入左房（LAX左室舒张期内径（LVDed）及室间隔OVSthX左
后壁厚度（LVPWth人于心尖四腔及右室两腔切面上，以 Dll模
式显示三尖瓣隔叶、前叶及后叶。将脉冲多普勒取样容积分别置
于前叶、隔叶和后叶的瓣环处，取样线与瓣环处夹角控制在30”
内，滤波设置为100HZ，取得此处速度频谱，分别测量此三处舒张
早期、舒张晚期的速度峰值及等容舒张时间，取3－5个心动周期
的平均值为该处运动速度值及等容舒张时间，再以三叶瓣环的平
均值为各组的平均Ea人a＊VRT，同时计算Ea／Aa。
左室重量指数：LVMI（／m勺二LVM（左室重量）／BSA（体表面积）
LVM（g）二0．8 XI．e X ［（WSth＋LVPWth＋LVDed）3－
LyDed3］＋0．6
相对室壁厚度：RWT二0VSth＋LVPWth＊LVDed
正常值：wm：男＜＊1砂＜＼女＜106吵m＼＊WT＜0．M
正常左室构型组：LVMI及RWT均在正常范围内。
向心性重构组：RWT超过正常范围，LVMI在正常范围内。
向心性肥厚组：LVMI及RW’I’均超过正常范围。
离心性肥厚组：LVMI超过正常范围8WT在正常范围内。
统计处理：应用SPSS10．0统计软件。测量与计算结果用均值
士标准差表示，使用非配对资料的t检验，P＜o．05为差异有显著
意义。
实验结果【
1．对照组与原发性高血压各组常规超声参数比较
·2·
五组研究对象间的年龄、性别无显著差别。从左室重量指数
和相对室壁厚度两指标来看，皿 ＊组的心脏重量明显增加，皿组
的相对室壁厚度最厚J组的相对室壁厚度变薄。同对照组相比，
在原发性高血压各组中＊组的右心房形态变化较其它三组明显。
2．对照组与原发性高血压各组Di参数比较
与对照组相比，原发性高血压各组的平均EatAa值均小于1，
各组的平均ES值也显著减低汀＜0．of人各组平均IVRT均增
加，呈递增趋势（0．102，0．119，0．132，0．137），11、皿J组与对照
组比较有显著差异P＜o．01入但1组无意义；各组平均Aa均高
于对照组，也表现为递增趋势（12．44，12．74，14．18，14．2），但只有
皿J组有显著意义瞩＜o．05八原发性高血压各组三尖瓣前、
后叶瓣环的 Ea／Aa值均小于儿 IJ及皿组隔叶的 Ea／Aa值也小
于1。
讨 论
右室在维持循环方面具有很重要的作用，右室功能对临床病
人的许多问题如治疗方法、预后等是非常重要的。右心功能受损
及随之引起的一系列的病理生理改变，在一定条件下，可引起急慢
性冠状动脉病变和瓣膜心脏病。此外，右心功能受损对左心功能
不全病人的生存率有很大的影响，对先天性心脏病病人（手术治
疗和未做手术）的存活率也有影响。POlak等研究报道，冠心病伴
心衰患者，右心射血分数高的患者两年生存率明显高于射血分数
低的。右室功能受损同败血症休克有关。Fuster等报道，右室功
能对法鲁氏四联征术后长期效果有很重要的影响。右室腔形态复
杂难，测量左室的公式和模型不适用于右室，因此找到一个较好的
测量右室功能的方法是非常必要的和有意义的。DTI是一种新的
超声技术，其对右心功能的测定不需通过描绘右心腔
Preface
Essential hypertension is one of the mankind's common diseases, not merely incidence rate in population is high, and can cause the serious harm of important organs, such as blood vessel, heart, brain, kidney, etc. For many years, there are a lot of reports about essential hypertension impair function of heart, It is mainly about the left ventricular function, the change of the right ventricular function is relatively less in research, But the right ventricular function has very important in maintaining circulation. So, it is a very essential and meaningful to find a better measurement right ventricular function method. Doppler tissue imaging is a newer ultrasonic inspection method. This technology is to use the low open wave filter to delete the blood flow signal, deal with the return waves echo signal of high amplitude, low speed organized, Show heart message practical thing of sport that comes out in the form of two - dimentional colored picture or the frequency spectrum curve. Use DTI measurement right ventricular function, have the following merits; Neednt draw right ventricular membrane in the heart, because it is very difficult to draw right ventricular membrane accurate; Neednt calculate right room capacity, because of right ventricle's form that without accurate mathematics model come and calculate right ventricular capacity. So it measure result have high credibility and repetitiveness.
Material and method
Research object: normal contrast group of 20 subjects ( males 10,females 10,age 29-68 years, 53.77+5. 69 years). Case group of 60 patients, classify method according to Gannu, and relative wall thickness ( RWT) divide into four groups with left ventricular weight index ( LVMI) , Normal left ventricular construct group( I group): males 9, females 5, age 55. 35+10.44 years; centripetal reconstruct group ( II group) : males 6, females 7, Age 50. 8+11.12 years; concentric hypertrophy group(III group) : males 10, females 8, Age 56. 65+13. 45 years; eccentric hypertrophy group( IVgroup) : males 7, females 8, Age 61. 3+14. 07 years. These patients that diabetes, rheumatic mitral valve, arrhythmia, pulmonary hypertension were exclude.
Ultrasonic examination: Both patients and control subjects underwent conventional two-dimensional echocardiography with the instrument of HPSonos with a 2 - 4MHz phased array transducer and DTI software with the patients in the left lateral decubitus position. In each patients, parasternal long axis view were taken to detect the AO, LA, LVDed, IVSth, LVPWth. Then the DTI was activated at apical four -chamber and right ventricular two - chamber view to detect peak velocity and IVRT of TV at early and late term of diastole by pulse Doppler. Making averages of 3 - 5 cardiac cycle as its values, then make averages of tricuspid annulus as average Ea,Aa,IVRT of each group and calculate Ea/Aa at same time. Left ventricular muscle index: LVMI(g/m2) =LVM(left ventricular muscle )/BSA ( body surface area) ,LVM(g) =0. 8 + 1. 04 + [ (IVSth + LVPWth + LVDed)3
- LVDed3 ] + 0. 6, relative wall thickness RWT = ( IVSth + LVP-Wth)/LVDed, normal value; LVMI: males < 111g/m2, females < 106g/m2, RWT< 0.44, I group: LVMI and RWT are in the normal range, H group: RWT exceeds normal range, LVMI is in the normal range, IIIgroup: LVMI and RWT exceed the normal range, IVgroup: LVMI exceeds the normal range, RWT is in the normal range.
Statistical analysis; all data acquired was analyzed using SPSS 10.0 software. P <0.05 has remarkable meanings for the difference.
Results
These parameters were contrast of contrast group and essential hypertension group; There are not difference about age and sex of five group subjects, LVM is obviously increases of M , IV group. RWT of III group is the thickest, RWT of IV group is thin. Compared with contrast group, the size of right atrium was changed obviously in IVgroup.
average Ea/Aa values of essential hypertension every group is smaller than 1, average Ea values of every group is decreased ( P, < 0. 01) ; Every group IVRT show a
引文
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2． Fuster V, McGoon DC, Kennedy MA. Long term evaluation of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980 ;46: 635-42．
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8． Fuster V, McGoon DC, Kennedy MA. Long term evaluation of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980 ;46 : 635-42．
9． Redington AN, Oldershaw PJ, Shinebourne EA, et al. A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of T etralogy of Fallot. Br Heart J 1988 ;60 :57-65．
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16． Cittadini A, Fazio S, Stromer H, et al. Optimal determination of right ventricular filling dynamics in systemic hypertension. Am Heart J 1995 ; 130 ( 5 ): 1074-82．
17. Habib GB, Zoghbi WA. Doppler assessment of right ventricular filling dynamics in systemic hypertension with left ventricular filling. Am Heart J 1992;124(5):1313-20.
18．任晓庆，王玉方，曹宁等，高血压对右室功能的影响．中华心血管杂志，1989；17：344-6．
2． Fuster V, McGoon DC, Kennedy MA. Long term evaluation of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980 ;46: 635-42．
3． Redington AN, Oldershaw PJ, Shinebourne EA, et al. A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of T etralogy of Fallot. Br Heart J 1988 ;60:57-65．
4． Ganau A, Devereux RB, Roman MJ, et al. Patterns left ventricular hypertrophy and geometric remodeling in essential hypertension. JACC, 1992, 19:1550-8．
5． Grose R, Strain J, Yipintosoi T. Right ventricular function in valvular heart disease: Relation to pulmonary artery pressure. J Am CoU Cardiol 1983 ;2: 225-32．
6． Pennington DG,Marjavy JP, Swartz MT, et al. The importance of biventricular failure in patients with postoperative cardiogenic shock. Ann Thorac Surg. 1985;39:16-9．
7． Polak JF, Holman BL, Wynne J, et al. Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease. JACC 1983;2:217-24．
8． Fuster V, McGoon DC, Kennedy MA. Long term evaluation of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980 ;46 : 635-42．
9． Redington AN, Oldershaw PJ, Shinebourne EA, et al. A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of T etralogy of Fallot. Br Heart J 1988 ;60 :57-65．
10． Redington AN, Rigby ML, Oldershaw PL, et al. Right ventricular function 10 years after the Mustard operation for tranposition of the great arters; analysis of size, shape, and wall motion. Br Heart J 1989 ;62:455-61．
11． Kimchi A , Ellrodt AG , Berman DS , et al. Right ventricular performance in sentic shock. J Am Coll Cardiol 1984;4;945-51．
12． (9) :662-5．
13． Wolk MJ, Keefe JF, Bing OHL,et al. Estimation of V maxianxo-tonic systoles from the rate of relative increase of isovolumic pressure : ( dp/dt) kp. J Clin Finest , 1971 ( 50 ) : 1276-85 .
14． Gressman W, Mclacerim LP, Rollett EL. Alteration in left ventricular relaxation and diastolic compliance in congestine cardio-myopathy. Cardiorase Res, 1979(13) :514-22．
15． Ferlinz J. Right Ventricular Performance in Essential Hypertension. Circulation 1980 ;61 ( 1 ) : 156-61 .
16． Cittadini A, Fazio S, Stromer H, et al. Optimal determination of right ventricular filling dynamics in systemic hypertension. Am Heart J 1995 ; 130 ( 5 ): 1074-82．
17. Habib GB, Zoghbi WA. Doppler assessment of right ventricular filling dynamics in systemic hypertension with left ventricular filling. Am Heart J 1992;124(5):1313-20.
18．任晓庆，王玉方，曹宁等，高血压对右室功能的影响．中华心血管杂志，1989；17：344-6．