实时三维超声心动图定量评价原发性高血压病患者左室重构与收缩同步性的临床研究

Real-time three-dimensional echocardiography in quantitative evaluation of left ventricular remodeling and systolic synchrony in patients with essential hypertension

摘要:

目的  利用实时三维超声心动图（RT-3DE）定量评价原发性高血压病（EH）患者左室重构与收缩同步性，并探讨两者之间的相关性。方法  将中南大学湘雅医学院附属海口医院2015年3月-2016年1月确诊的EH患者107例患者记作观察组，另选取同期正常体检者35例记作对照组，采用RT-3DE对两组患者进行检查，采用Qlab定量分析软件对数据进行定量评价，记录左室重构指数（LVRI）、左心室质量指数（LVMI）、左室舒张容积（LVEDV）及收缩末容积（LVESV）、左室射血分数（LVEF）和16节段达到最小收缩容积时的标准差（SDI）和最大差值（Tmsv16-Dif），并比较组间差异。结果  心电图QRS波4组间比较和两两比较差异均具有统计学意义（P <0.05）；观察组3个亚组和对照组比较，SDI、Tmsv16-Dif与LVMI、LVRI、LVEDV均增大（P < 0.05）；而C组SDI、Tmsv16-Dif与LVMI、LVRI与B组相比、B组与A组相比均增大（P <0.05）；SDI分别与LVEDV、LVESV及LVMI呈正相关，与LVEF呈负相关；Tmsv16-Dif与LVMI、LVEDV、LVESV呈正相关，与LVEF呈负相关。结论  RT-3DE能够准确测量出EH患者心脏各腔室的功能和容积准确测量，同时LVRI与LVMI均能对不同情况下心室重构的程度进行评估，SDI和Tmsv16-Dif可反应心室收缩不同步的情况。因此左室重构与收缩同步性定量评价对于EH患者病情判断具有重要意义。

Abstract:

Objective To quantitatively evaluate the left ventricular remodeling and systolic synchrony in patients with essential hypertension (EH) by real-time three-dimensional echocardiography (RT-3DE). Methods A total of 107 patients diagnosed as EH in our hospital from March 2015 to January 2016 were enrolled into observation group, and 35 cases of normal physical examination during the same period were recorded as the control group. The two groups were detected by RT-3DE, and the left ventricular remodeling index (LVRI), left ventricular mass index (LVMI), left ventricular end diastolic volume and systolic volume (LVEDV and LVESV), left ventricular ejection fraction (LVEF) and standard deviation index (SDI) and time of maximum systolic volume 16-difference (Tmsv16-Dif) were recorded and compared. Results There were significant differences in the ECG QRS wave among the four groups and between every two groups (P < 0.05). Compared with the control group, the SDI, Tmsv16-Dif, LVMI, LVRI and LVEDV were significantly increased in the three subgroups of the observation group (P < 0.05). The SDI, Tmsv16-Dif, LVMI and LVRI of the eccentric hypertrophy group were higher than those of the the concentric hypertrophy group, which were in turn higher than those of the normal configuration group (P < 0.05). The SDI and Tmsv16-Dif were positively correlated with LVEDV, LVESV and LVMI, and negatively correlated with LVEF. Conclusions RT-3DE can accurately measure the volume and function of each cardiac chamber in EH patients, and LVRI and LVMI can evaluate the degree of ventricular remodeling in different cases. SDI and Tmsv16-Dif can reflect the situation of non-synchronous ventricular contraction. Therefore, the quantitative evaluation of left ventricular remodeling and systolic synchrony has great significance in judging the condition of patients with EH.