Galderisi M, Caso P, Severino S, Petrocelli A, De Simone L, Izzo A, Mininni N, de Divitiis O
Cattedra di Medicina d'Urgenza, Istituto di Medicina e Clinica Sperimentale, Università Federico II di Napoli, Naples, Italy.
J Hypertens. 1999 May;17(5):685-93. doi: 10.1097/00004872-199917050-00013.
To assess regional diastolic function in patients with hypertension with or without left ventricular hypertrophy using Doppler tissue imaging, a new tool that analyzes myocardial wall motion 'on-line'.
Ten normotensive subjects, 20 hypertensive patients without hypertrophy and 20 with hypertrophy (left ventricular mass index >50 g/m2.7), all men, underwent Doppler echocardiography and Doppler tissue imaging, which was performed in apical view by placing pulsed sample volume at the level of the basal and middle septum, basal and middle lateral wall, and infero-posterior wall. Peak velocities and time-velocity integrals of myocardial early (Em) and late (Am) waves and their ratios, regional deceleration time and regional relaxation time were measured in each segment.
Transmitral peak E/A ratio was 1.37 in normotensive subjects, 1.01 in hypertensive patients without hypertrophy and 0.77 in those with hypertrophy (P < 0.00001). The myocardial diastolic indexes derived by Doppler tissue imaging worsened at all levels in hypertensive patients without hypertrophy compared with normotensive subjects. In hypertensive patients with hypertrophy, the majority of myocardial diastolic indexes were further impaired at the basal septal level, but only marginal differences were found in other regions, compared with indexes in hypertensive patients without hypertrophy. The main diastolic indexes were found, using separate intra-group analyses, to be more compromised at the basal septum than at other levels only in hypertrophic hypertensive patients. The prevalence of regions having peak Em/Am ratios < 1 increased significantly from normotensive subjects to hypertensive patients without hypertrophy, but not significantly from these to the hypertrophic group. Among pooled hypertensive patients, after adjusting for heart rate and diastolic blood pressure using multivariate models, the septal wall thickness was shown to be an independent determinant of the diastolic indexes of the basal and middle septum.
In hypertensive patients without hypertrophy, diastolic dysfunction is uniform along the ventricular walls, whereas in those with hypertrophy it is more evident at the basal septal level than in other walls. Overall among hypertensive patients, the diastolic properties of the interventricular septum worsen as the thickness of the septal wall increases, in the presence and in the absence of hypertrophy.
使用多普勒组织成像这一能够“在线”分析心肌壁运动的新工具，评估有或无左心室肥厚的高血压患者的局部舒张功能。
10名血压正常的受试者、20名无肥厚的高血压患者以及20名有肥厚的高血压患者（左心室质量指数>50g/m².⁷），均为男性，接受了多普勒超声心动图和多普勒组织成像检查，后者通过在心尖视图中将脉冲取样容积置于基底和中间间隔、基底和中间侧壁以及下后壁水平来进行。测量每个节段心肌早期（Em）和晚期（Am）波的峰值速度、时间速度积分及其比值、局部减速时间和局部松弛时间。
血压正常的受试者二尖瓣E/A峰值比值为1.37，无肥厚的高血压患者为1.01，有肥厚的高血压患者为0.77（P<0.00001）。与血压正常的受试者相比，无肥厚的高血压患者通过多普勒组织成像得出的心肌舒张指标在所有水平均恶化。在有肥厚的高血压患者中，与无肥厚的高血压患者相比，大多数心肌舒张指标在基底间隔水平进一步受损，但在其他区域仅发现微小差异。通过单独的组内分析发现，仅在肥厚性高血压患者中，主要舒张指标在基底间隔比在其他水平受损更严重。Em/Am峰值比值<1的区域患病率从血压正常的受试者到无肥厚的高血压患者显著增加，但从这些患者到肥厚组则无显著增加。在合并的高血压患者中，使用多变量模型校正心率和舒张压后，间隔壁厚度显示为基底和中间间隔舒张指标的独立决定因素。
在无肥厚的高血压患者中，舒张功能障碍沿心室壁是均匀的，而在有肥厚的患者中，在基底间隔水平比在其他壁更明显。总体而言，在高血压患者中，无论有无肥厚，随着间隔壁厚度增加，室间隔的舒张特性都会恶化。
