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目的通过超声心动图检查探讨老年舒张性心力衰竭(diastolic heart failure,DHF)患者心脏结构及舒张和收缩功能的变化情况。方法对129例老年DHF患者(DHF组)和79例年龄匹配的健康老年人(对照组)进行超声心动图检查,测量左心室容积、左心房容积、左心室质量,获取二尖瓣血流、右上肺静脉血流频谱,用组织多普勒测量二尖瓣环心室长轴方向的收缩期心肌峰值运动速度(Sm)、舒张早期心肌峰值运动速度(Em)等值,并进行分析。结果与对照组比较,DHF组患者左心室舒张末容积指数轻度增大,左心室质量指数明显增大,左心房容积指数明显增大,Sm和Em均明显下降,差异均有统计学意义(P<0.01)。相关分析显示,Sm与左心室质量指数独立相关(β=-0.018,P<0.01),左心房容积指数与老年DHF患者舒张功能不全程度独立相关(β=0.002,P<0.01)。结论老年DHF患者总体表现为显著的向心性增厚,左心房的大小与舒张功能受损程度相关;收缩与舒张功能的损害,可能共同参与老年DHF发生和发展的过程。
Objective To investigate the changes of cardiac structure and diastolic and systolic function in elderly patients with diastolic heart failure (DHF) by echocardiography. Methods Echocardiography was performed on 129 elderly DHF patients (DHF group) and 79 age-matched healthy controls (control group). Left ventricular volume, left atrium volume and left ventricular mass were measured to obtain mitral flow, Right upper pulmonary vein blood flow spectrum was measured by tissue Doppler measurement of mitral annular center systolic myocardial peak velocity (Sm), diastolic early myocardial peak velocity (Em) equivalent and analyzed. Results Compared with the control group, the left ventricular end-diastolic volume index was slightly increased, the left ventricular mass index was significantly increased, the left atrial volume index was significantly increased, and the Sm and Em were significantly decreased in the DHF group (all were statistically significant ( P <0.01). Correlation analysis showed that Sm correlated independently with left ventricular mass index (β = -0.018, P <0.01). Left atrial volume index was independently associated with diastolic dysfunction in elderly patients with DHF (β = 0.002, P <0.01). Conclusions The elderly patients with DHF generally show significant concentric thickening. The size of the left atrium is related to the degree of diastolic dysfunction. The impairment of systolic and diastolic function may participate in the occurrence and development of elderly DHF.