基于组织多普勒成像的冠状动脉造影检查中，左室射血分数保留的高血压患者收缩期变形和不同步指数与左室肥厚程度的相关性。

Correlation between systolic deformation and dyssynchrony indices and the grade of left ventricular hypertrophy in hypertensive patients with a preserved systolic ejection fraction undergoing coronary angiography, based on tissue Doppler imaging.

机构信息

Department of Echocardiography, Tehran Heart Center, North Kargar Street, Tehran 14117 13138, Iran.

出版信息

J Ultrasound Med. 2014 Jan;33(1):119-28. doi: 10.7863/ultra.33.1.119.

DOI:10.7863/ultra.33.1.119

PMID:24371106

Abstract

OBJECTIVES

The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy.

METHODS

A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole.

RESULTS

The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal-lateral wall delay (r = 0.497), 6-basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = -0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end-systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839-26.980; P = .0044).

CONCLUSIONS

Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.

摘要

目的

本研究旨在探讨在冠状动脉正常且射血分数正常的高血压患者中是否存在收缩期机械不同步，并分析其与不同程度左心室（LV）肥厚的关系。

方法

共纳入 125 例经冠状动脉造影正常的患者（42.4%为男性；平均年龄±标准差，57.16±8.26 岁），其射血分数均大于 50%，其中 84 例为高血压患者，41 例为血压正常患者。将高血压患者分为 3 组：无 LV 肥厚、LV 轻度肥厚和 LV 中度肥厚。在收缩期峰值时，测量 6 个 LV 基底段的组织多普勒和应变参数。

结果

与对照组患者（19.5%）相比，高血压患者的不同步发生率为 40.5%（P=0.020）。在高血压患者中，无肥厚患者中有 5 例（20%）、轻度肥厚患者中有 20 例（42.6%）、中度肥厚患者中有 9 例（75%）存在 LV 不同步。LV 肥厚程度与室间隔-侧壁延迟（r=0.497）、6 个基底段延迟（r=0.454）、整体应变（r=0.453）、整体收缩期峰值速度（r=-0.430）和基底段收缩期峰值速度标准差（r=0.429）之间呈中度相关。在校正 LV 收缩末期直径和体表面积后，整体应变与肥厚程度的相关性最好（比值比，7.043；95%置信区间，1.839-26.980；P=0.0044）。