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目的:应用二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)技术定量评价原发性高血压患者左室肥厚对右心室功能的影响。方法:收集我院确诊为原发性高血压的患者共60例,将左室质量指数(left ventricular mass index,LVMI),男性≥115 g/m~2,女性≥95 g/m~2的患者分左室肥厚组(B组30例),其余为无肥厚组(A组30例)。行常规超声及二维斑点追踪检查并检测右心室功能指标,包括心室大小、左室壁厚度、左室射血分数(left ventricular ejection fraction,LVEF)、三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、右室面积变化率(right ventricular fractional area change,RVFAC)、左室全局纵向峰值收缩期应变(left ventricular global longitudinal peak systolic strain,LVGLS)及右心室游离壁及间隔的各节段纵向峰值收缩应变。结果:2组间心室大小、LVEF、TAPSE、RVFAC均无统计学差异(P>0.05)。B组室壁厚度及左室质量指数显著高于A组。B组LVGLS及右心室游离壁及间隔的各节段纵向峰值收缩应变均明显低于A组(P<0.05)。LVGLS与TAPSE、RVFAC、右心室游离壁基底段、中段、心尖段及间隔的基底段、中段、心尖段纵向峰值收缩应变呈正相关(r分别为0.606、0.333、0.379、0.289、0.384、0.500、0.515、0.317,P<0.05);LVMI与TAPSE、RVFAC无明显相关,与右心室游离壁基底段、中段、心尖段及间隔的基底段、心尖段纵向峰值收缩应变呈负相关(r分别为-0.318、-0.305、-0.328、-0.340、-0.268,P<0.05)。结论:斑点追踪可定量评价原发性高血压患者左室肥厚对右心室功能的影响,且优于常规超声。左室肥厚及左室整体功能损伤可间接影响右心室功能。
Objective: To evaluate the effect of left ventricular hypertrophy on right ventricular function in patients with essential hypertension by using two-dimensional speckle tracking imaging (2D-STI). Methods: A total of 60 patients with primary hypertension diagnosed in our hospital were collected. Left ventricular mass index (LVMI), male ≥ 115 g / m ~ 2, female ≥ 95 g / m ~ 2 Patients were divided into left ventricular hypertrophy group (B group, 30 cases), the rest without the hypertrophy group (A group, 30 cases). The left ventricular ejection fraction (LVEF), tricuspid annular plane displacement (Tricuspid annular plane) and left ventricular ejection fraction systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), left ventricular global longitudinal peak systolic strain (LVGLS) and right ventricular free wall and interval Section longitudinal peak shrinkage strain. Results: There was no significant difference in ventricular volume, LVEF, TAPSE and RVFAC between the two groups (P> 0.05). B group wall thickness and left ventricular mass index was significantly higher than the A group. The longitudinal peak systolic strain in each group of LVGLS and right ventricular free wall and interval in group B was significantly lower than that in group A (P <0.05). There was a positive correlation between LVGLS and TAPSE, RVFAC, right ventricular free wall basal segment, middle segment, apical segment and basal segment, middle segment and apical segment of longitudinal peak systolic strain (r = 0.606,0.333,0.379,0.289,0.384,0.500,0.515 , 0.317, P <0.05). There was no significant correlation between LVMI and TAPSE and RVFAC, and there was a negative correlation between LVMI and RVPE in basal segment, middle segment, apical segment and basal segment of isolated right ventricle and longitudinal peak systolic strain in apical segments (r = -0.318 , -0.305, -0.328, -0.340, -0.268, P <0.05). Conclusion: Speckle tracking can quantitatively evaluate the effect of left ventricular hypertrophy on right ventricular function in patients with essential hypertension, and is superior to conventional ultrasound. Left ventricular hypertrophy and left ventricular overall functional impairment can indirectly affect right ventricular function.