原发性醛固酮增多症患者右心室功能的斑点追踪超声心动图研究。

A speckle tracking echocardiographic study on right ventricular function in primary aldosteronism.

机构信息

Centre for Cardiovascular Evaluations, The Shanghai Institute of Hypertension, Department of Hypertension, Shanghai Key Lab of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

J Hypertens. 2020 Nov;38(11):2261-2269. doi: 10.1097/HJH.0000000000002527.

DOI:10.1097/HJH.0000000000002527

PMID:32618893

Abstract

OBJECTIVE

We investigated right ventricular function using speckle tracking echocardiography (STE) in patients with primary aldosteronism.

METHODS

Our study included 51 primary aldosteronism patients and 50 age and sex-matched primary hypertensive patients. We performed two-dimensional echocardiography to measure cardiac structure and function. We performed STE offline analysis on right ventricular four-chamber (RV4CLS) and free wall longitudinal strains (RVFWLS).

RESULTS

Primary aldosteronism patients, compared with primary hypertensive patients, had a significantly (P ≤ 0.045) greater left ventricular mass index (112.0 ± 22.6 vs. 95.8 ± 18.5 g/m) and left atrial volume index (26.9 ± 6.0 vs. 24.7 ± 5.6 ml/m) and higher prevalence of left ventricular concentric hypertrophy (35.3 vs. 12.0%), although they had similarly normal left ventricular ejection fraction (55-77%). Primary aldosteronism patients also had a significantly (P ≤ 0.047) larger right atrium and ventricle, lower tricuspid annular plane systolic excursion, and higher E/E't (the peak early filling velocity of trans-tricuspid flow to the peak early filling velocity of lateral tricuspid annulus ratio), estimated pulmonary arterial systolic pressure and right ventricular index of myocardial performance. On the right ventricular strain analysis, primary aldosteronism patients had a significantly (P < 0.001) lower RV4CLS (-18.1 ± 2.5 vs. -23.3 ± 3.4%) and RVFWLS (-21.7 ± 3.7 vs. -27.9 ± 4.5%) than primary hypertensive patients. Overall, RV4CLS and RVFWLS were significantly (r = -0.58 to -0.41, P < 0.001) correlated with plasma aldosterone concentration and 24-h urinary aldosterone excretion. After adjustment for confounding factors, the associations for RV4CLS and RVFWLS with 24-h urinary aldosterone excretion remained significant (P < 0.001), with a standardized coefficient of -0.48 and -0.55, respectively.

CONCLUSION

In addition to left ventricular abnormalities, primary aldosteronism patients also show impaired right ventricular function, probably because of hyperaldosteronism.

摘要

目的

应用斑点追踪超声心动图（STE）评估原发性醛固酮增多症患者的右心室功能。

方法

本研究纳入了 51 例原发性醛固酮增多症患者和 50 例年龄、性别匹配的原发性高血压患者。行二维超声心动图测量心脏结构和功能，离线分析右心室四腔心（RV4CLS）和游离壁纵向应变（RVFWLS）。

结果

与原发性高血压患者相比，原发性醛固酮增多症患者的左心室质量指数（112.0 ± 22.6 比 95.8 ± 18.5 g/m）和左心房容积指数（26.9 ± 6.0 比 24.7 ± 5.6 ml/m）显著增加（P ≤ 0.045），左心室向心性肥厚的患病率也更高（35.3%比 12.0%），尽管左心室射血分数（55-77%）相似。原发性醛固酮增多症患者的右心房和右心室也显著增大（P ≤ 0.047），三尖瓣环平面收缩期位移降低，E/E't（经三尖瓣口的早期充盈速度与外侧三尖瓣环的早期充盈速度之比）升高，估算肺动脉收缩压和右心室心肌做功指数也升高。在右心室应变分析中，原发性醛固酮增多症患者的 RV4CLS（-18.1 ± 2.5 比 -23.3 ± 3.4%）和 RVFWLS（-21.7 ± 3.7 比 -27.9 ± 4.5%）显著低于原发性高血压患者（P < 0.001）。总体而言，RV4CLS 和 RVFWLS 与血浆醛固酮浓度和 24 小时尿醛固酮排泄量呈显著负相关（r = -0.58 至-0.41，P < 0.001）。调整混杂因素后，RV4CLS 和 RVFWLS 与 24 小时尿醛固酮排泄量的相关性仍具有统计学意义（P < 0.001），标准化系数分别为-0.48 和-0.55。