Huang J, Fan Y Y, Tang D, Shen Dan
Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou 213003, China.
Department of Echocardiography, the Second Affiliated Hospital of Dalian Medical University, Dalian 116000, China.
Zhonghua Yi Xue Za Zhi. 2022 May 10;102(17):1290-1296. doi: 10.3760/cma.j.cn112137-20211125-02632.
To explore the application values of right atrial (RA) volume, myocardial strain and strain rate in evaluating right atrial functions in patients with essential hypertension (EHT) with normal left ventricular ejection fraction (LVEF). We retrospectively collected a total of 126 EHT patients with normal LVEF, including 66 males and 60 females, age from 18 to 83(48±15) years from the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University from March, 2018 to May, 2020. According to the left ventricular mass index, those patients were divided into without left ventricle hypertrophy (LVH) group (=66) and LVH group (=60), and 83 healthy volunteers were enrolled as control group, which including 42 males and 41 females, age from 14 to 88 (48±16) years. The total, passive and active RA emptying fraction (total RAEF, passive RAEF and active RAEF) were measured by using RA volumes method. The RA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump) were measured by two-dimensional speckle tracking echocardiography. Total RAEF, S-reservoir, and Sr-reservoir represented the reservoir function, while passive RAEF, S-conduit, and Sr-conduit represented the conduit function, and active RAEF, S-booster pump and Sr-booster pump represented the booster pump function, respectively. Than the values between the EHT patients and normal subjects, and the values among the EHT patients without LVH, EHT patients without LVH and normal subjects were compared. The value of active RAEF was significantly lower in EHT patient than normal controls (40.1%±10.5% vs 45.4%±11.1%,=0.001). There were significant differences among EHT patients without LVH, EHT patients with LVH and normal subjects in passive RAEF and active RAEF (passive RAEF: 40.2%±9.3% vs 36.4%±10.7% vs 36.5%±9.4%, =0.038, active RAEF: 39.8%±10.6% vs 40.4%±10.4% vs 45.4%±11.1%, =0.002). There were significant differences in S-reservoir, S-conduit, S-booster pump, SR-reservoir, SR-conduit and SR-booster pump between EHT patients and normal subjects [S-reservoir: 34.8%±13.7% vs 45.0%±13.3%, S-conduit: 18.3%±9.4% vs 26.5%±9.6%, S-booster pump: 16.4%±7.3% vs 18.6%±7.1%, SR-reservoir: (1.6±0.6)/s vs (2.0±0.6)/s, SR-conduit: (-1.2±0.5)/s vs (-1.6±0.6)/s, SR-booster pump: (-1.7±0.6)/s vs (-2.3±0.6)/s; all <0.05]. The trend tests showed normal controls achieved the largest the absolute values of S-reservoir, S-conduit, SR-reservoir, SR-conduit, SR-booster pump, followed by EHT patients without LVH and EHT patients with LVH(all <0.001). Using RA volume, myocardial strain and strain rate can detect the RA impaired reservoir, conduit, and the booster pump functions in EHT patients with normal LVEF, and the RA functions were damaged more significantly in EHT patients with LVH.
探讨右心房(RA)容积、心肌应变及应变率在评估左心室射血分数(LVEF)正常的原发性高血压(EHT)患者右心房功能中的应用价值。我们回顾性收集了2018年3月至2020年5月期间南京医科大学附属常州第二人民医院的126例LVEF正常的EHT患者,其中男性66例,女性60例,年龄18至83(48±15)岁。根据左心室质量指数,将这些患者分为无左心室肥厚(LVH)组(n = 66)和LVH组(n = 60),并纳入83名健康志愿者作为对照组,其中男性42例,女性41例,年龄14至88(48±16)岁。采用RA容积法测量右心房总排空分数、被动排空分数和主动排空分数(总RAEF、被动RAEF和主动RAEF)。采用二维斑点追踪超声心动图测量右心房应变(S-储器、S-管道、S-增压泵)和应变率(SR-储器、SR-管道、SR-增压泵)。总RAEF、S-储器和Sr-储器代表储器功能,被动RAEF、S-管道和Sr-管道代表管道功能,主动RAEF、S-增压泵和Sr-增压泵分别代表增压泵功能。然后比较EHT患者与正常受试者之间的值,以及无LVH的EHT患者、有LVH 的EHT患者与正常受试者之间的值。EHT患者的主动RAEF值显著低于正常对照组(40.1%±10.5% 对45.4%±11.1%,P = 0.001)。无LVH的EHT患者、有LVH的EHT患者与正常受试者在被动RAEF和主动RAEF方面存在显著差异(被动RAEF:40.2%±9.3% 对36.4%±10.7% 对36.5%±9.4%,P = 0.038;主动RAEF:39.8%±10.6% 对40.4%±10.4% 对45.4%±11.1%,P = 0.002)。EHT患者与正常受试者在S-储器、S-管道、S-增压泵、SR-储器、SR-管道和SR-增压泵方面存在显著差异[S-储器:34.8%±13.7% 对45.0%±13.3%,S-管道:18.3%±9.4% 对26.5%±9.6%,S-增压泵:16.4%±7.3% 对18.6%±7.1%,SR-储器:(1.6±0.6)/s对(2.0±0.6)/s,SR-管道:(-1.2±0.5)/s对(-1.6±0.6)/s,SR-增压泵:(-1.7±0.6)/s对(-2.3±0.6)/s;均P < 0.05]。趋势检验显示,正常对照组的S-储器、S-管道、SR-储器、SR-管道、SR-增压泵绝对值最大,其次是无LVH的EHT患者和有LVH的EHT患者(均P < 0.001)。使用RA容积、心肌应变及应变率可检测LVEF正常的EHT患者右心房储器、管道及增压泵功能受损情况,且有LVH的EHT患者右心房功能受损更显著。