Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Am J Cardiol. 2013 Jul 15;112(2):260-5. doi: 10.1016/j.amjcard.2013.03.025. Epub 2013 Apr 15.
The acute impact of hypertensive crisis, and changes after treatment, on left ventricular (LV) systolic and diastolic function using comprehensive echocardiography, including speckle tracking, has not been well characterized. Thirty consecutive patients admitted to the hospital from the emergency room with hypertensive crisis underwent Doppler echocardiography at baseline and after blood pressure optimization. The mean age of the patients was 54 ± 13 years, with 19 men (63%). The most common presenting symptoms included dyspnea (70%), chest pain (43%), and altered mental status (13%). Mean systolic and diastolic blood pressures at presentation were 198 ± 12 and 122 ± 12 mm Hg, decreasing to 143 ± 15 and 77 ± 12 mm Hg (p <0.001 for both) after treatment. There was no significant change in LV ejection fraction between baseline and follow-up (48 ± 18% vs 46 ± 18%, p = 0.50); however, global longitudinal LV systolic strain (-10 ± 4% to -12 ± 4%, p = 0.01) and global systolic strain rate (-1.0 ± 0.4 vs -1.4 ± 0.6 s(-1), p = 0.01) significantly improved. Mean global early diastolic strain (-7.2 ± 4.0% to -9.4 ± 2.9%, p = 0.004) and early diastolic strain rate (0.3 ± 0.2 to 0.5 ± 0.4 s(-1), p = 0.05) also improved after treatment. On multivariate analysis, the independent predictors of LV longitudinal strain at follow-up were LV ejection fraction (p <0.001), heart rate (p = 0.005), systolic blood pressure (p = 0.04), and left atrial volume index (p = 0.05). In conclusion, as opposed to LV ejection fraction, LV systolic strain and strain rate were depressed during hypertensive crisis and significantly improved after medical treatment. LV diastolic function, assessed using conventional and speckle-tracking parameters, was also depressed and significantly improved after treatment.
高血压危象对左心室（LV）收缩和舒张功能的急性影响，以及治疗后的变化，使用包括斑点追踪在内的综合超声心动图尚未得到很好的描述。30 名连续因高血压危象从急诊室入院的患者在基线和血压优化后接受了多普勒超声心动图检查。患者的平均年龄为 54 ± 13 岁，其中 19 名男性（63%）。最常见的表现症状包括呼吸困难（70%）、胸痛（43%）和精神状态改变（13%）。就诊时的平均收缩压和舒张压分别为 198 ± 12 和 122 ± 12mmHg，治疗后分别降至 143 ± 15 和 77 ± 12mmHg（均<0.001）。LV 射血分数在基线和随访之间没有显著变化（48 ± 18%对 46 ± 18%，p=0.50）；然而，整体纵向 LV 收缩应变（-10 ± 4%对-12 ± 4%，p=0.01）和整体收缩应变率（-1.0 ± 0.4 对-1.4 ± 0.6 s(-1)，p=0.01）显著改善。平均整体早期舒张应变（-7.2 ± 4.0%对-9.4 ± 2.9%，p=0.004）和早期舒张应变率（0.3 ± 0.2 对 0.5 ± 0.4 s(-1)，p=0.05）在治疗后也有所改善。多变量分析显示，随访时 LV 纵向应变的独立预测因子为 LV 射血分数（p<0.001）、心率（p=0.005）、收缩压（p=0.04）和左心房容积指数（p=0.05）。总之，与 LV 射血分数不同，LV 收缩应变和应变率在高血压危象期间下降，并在药物治疗后显著改善。使用传统和斑点追踪参数评估的 LV 舒张功能在治疗后也下降并显著改善。
