超声心动图及应变率技术对高血压患者心房结构和功能的研究
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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。
Objective
To 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.
Methods
30 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.
Results
1.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)。
Conclusion
1.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.
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。
Objective
To 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.
Methods
30 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.
Results
1.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)。
Conclusion
1.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.
引文
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[28]Kranidis A,Kostopoulos K,Anthopoulos L.Evaluation of left ventricular filling by echocardiograph atrioventricular Plane displacement in patients with coronary artery disease.Int J Cardiol,1995,Feb,48(2):183-186
[29]孙铁军,吕发勤,马彩娥.超声心动图房室平面位移法对冠心病患者左心室舒张功能的评价.中国心血管杂志,1999,4(6):91-92
[30]Takatsuji H,Mikami T,Urasawa K,et al.A new approach for evaluation of left ventricular diastolic function:Spatial and temporal analysis of left ventricular filling flow propagation by M-mode echocardiograph.J Am Coll Cardiol,1996,27(2):365-371.
[31]Garcia MJ,Smedira NG,Greenberg NL,et al.Color M-mode Doppler flow Propagation velocity is a preload insensitive index of left ventricular relaxation:animal human validation.J Am Coll Cardlol,2000,35(1):201-208
[32]Chenzbrau,Pinto FJ,Popylisen S,et al.Filling Patterns in left ventricular hypertrophy:a combined acoustic quandfication and Doppler study.J Am Coll Cardiol,1994,23(5):1179-1185
[33]Nagueh SF,Middleton KJ,Kopelen HA,et al.Doppler tissue imaging:a noninvasive technique of evaluation of left ventricular relaxation and estimation of filling pressures.J Am Coll Cardiol,1997,30(6):1527-1533
[34]Oki T,Tabata T,Yamada H,et al.Climcal application of Pulsed Doppler Tissue Imaging of assessing abnormal left ventricular relaxation.J Am Coll Cardiol,1997,79(7):921-928
[35]张立君,黄华,声学定量技术评价原发性高血压患者左房功能[J],实用心脑肺血管病杂志,2006,14(3),235-236.
[36]John T,Miller J T,O'Rouke R A,et al.Left arterial enlargement:An early sign of hypertensive heart disease[J].Am Heart J,1998,116:1048.
[37]Adebayo AK,Oladapo OO,Adebiyi AA,Changes in left atrial dimension and function and left ventricular geometry in newly diagnosed untreated hypertensive subjects[J].J Cardiovasc Med(Hagerstown).2008 Jun;9(6):561-9 PMID:18475123
[38]张晓茹,刘新乔,柴永红,焦晓云.超声心动图对高血压病左房结构改变及左室舒张功能的观察[J],中国民康医学,2007,19(8):681.
[39]李芹.高血压病对心脏左心房构型及功能的影响[J].中华超声影像学杂志,2001,10(3):143.
[40]李名龙,葛艺东,多普勒超声心动图评价高血压病左房构形及功能变化[A],皖南医学院学报,2005,24(2):20-121.
[41]Hoit BD.Assessing atrial mechanical remodeling and it sconsequences Circulation,2005,112(3):304
[42]温朝辉,吴长君,温朝阳,等超声心动图快速评价高血压心脏病左心房收缩功能.中国医学影像技术.2005,21(5):718
[43]Zhang Q,Kum LC,Lee PW,et al.Effect of age and heart rate on atria mechanical function assessed by Doppler tissue imaging in Healthy individuals[J].J Am SocEchocardiogr,2006,19(4):422-428.PMID:16581481
[44]Oki T,Tabata T,Yamada H,et al:Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation[J].Am J Cardiol,1997,79:921-928.
[45]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].J Am Coll Cardiol,1997,30:474-480.
[46]李利,张军,周晓东,等.房间隔应变率成像鉴别左室舒张功能假性正常表现[J],中国医学影响技术,2006,22(5):695-697
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[48]Gottdiener JS,Bednarz J,Devereux R,et al:American Society of Echocardiography recommendations for use of echocardiography in clinical trials[J].J Am Soc Echocardiographay,2004,17:1086-1119.
[49]Mottram PM,Marwick TM:Assessment of diastolic function:what the general cardiologist needs to know.Heart,2005,91:681-695.
[50]De Boeck BW,Cramer MJ,oh JK,et al:Spectral pulsed Doppler imaging in diastole:a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle[J].Am Heart J,2003,146:411-419.
[51]舒先红,黄国倩,潘翠珍,等.正常人心肌应变及应变率定量分析.中华超声影像学杂志,2004,13(11):805
[52]Kim DG,Lee KJ,Lee S,Feasibility of Two-Dimensional Global Longitudinal Strain and Strain Rate Imaging for the Assessment of Left Atrial Function:A Study in Subjects with a Low Probability of Cardiovascular Disease and Normal Exercise Capacity[J]..Echocardiography.2009 Aug 28.PMID:19725856
[53]王志浩,张薇,谭红伟.等.高血压病合并频发室性期前收缩患者左心房局部功能的应变及应变率评价.中华超声影像学杂志.2007.16(3):198
[54]Thomas L,McKay T,Byth K,et al.Abnormalities of left atrial function after cardioversion:an atrial strain rate study[J].heart,2007.93(1):89
[55]徐长新,朱杰,杨宏宇.PDE研究高血压病左室肥厚各型对右心功能的影响[J].中国医学髟像技术,2000,16(9):752-753
[56]高敬,华琦,超声心动图评价高血压患者心脏结构及功能的改变[J],中国医学影像技术,2003,19(9):1134-1136.
[57]孙静平,等.原发性高血压患者右心功能的特点[J]中华内科杂志,1991.30(6):89
[58]Habib G B,Zoghbi W A.Doppler assessment of right ventricular filling dynamics in systemic hypertension:comparison with left ventricular filling[J].Am Heart J,1992,124:1313.
[59]Ferlinz J,Right ventricular performance in essential hypertension[J].Circulation,1980,61:156.
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[61]吴庚华,朱永泽,吴洪海.白发性高血压大鼠右心房心肌细胞超微结构的观察[J].实用临床医药杂志,2004,8(3):45-48.
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[63]刘新琼.原发性高血压左房扩大与心房纤颤发生率相关分析[J].中国自然医学杂志,2006,6:97-100.
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