摘要
目的 探讨高血压性左心室肥厚及射血分数保留的心力衰竭（HF－PEF）患者左心室同步性变化，明确收缩失同步对心功能的影响。方法 回顾性分析2011年6月至2014年5月间天津市胸科医院诊治的352例原发性高血压患者资料，其中男160例，女192例，年龄（67.6±7.8）岁。根据心脏超声及G－MPI相位分析技术，利用单因素方差分析、χ^2检验比较各组患者的心脏超声参数、相位直方图带宽（PHB）、相位标准差（PSD）和血清BNP值。对于HF－PEF患者，采用偏相关分析探讨BNP与PHB、PSD及其他临床因素的关系。结果 按相应诊断标准，将352例原发性高血压患者分成3组，分别是单纯高血压组（182例）、左心室肥厚组（74例）和HF－PEF组（96例）。与单纯高血压组相比，左心室肥厚组和HF－PEF组均存在：（1）显著心室肥厚，左心室质量指数（LVMI）分别为（121.1±9.8）和（123.2±10.9） g/m^2，显著高于单纯高血压组的（94.4±10.1） g/m^2（F＝8.66，P〈0.05）；（2）舒张功能减低，舒张早期和舒张晚期二尖瓣血流速率比值（E/A）分别为0.80±0.28和0.67±0.17，显著低于单纯高血压组的1.19±0.23（F＝13.46，P〈0.05）。但3组间LVEF均正常，分别为（58.6±7.3）%、（60.8±10.4）%和（55.1±4.6）%（F＝2.89，P〉0.05）。HF－PEF组存在明显的左心室收缩的失同步，PHB、PSD分别为（88.4±8.6）°、（23.6±1.9）°，血清BNP水平显著高于左心室肥厚组[（228.4±69.7） ng/L和（92.5±13.6） ng/L；q＝8.63，P〈0.05]；血清BNP值与PHB、PSD及LVMI呈正相关（r＝0.277～0.331，均P〈0.05）。结论 高血压所致HF－PEF患者存在明显左心室收缩的失同步，该同步性异常和心力衰竭严重程度有关。
Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy （LVH） or with heart failure but preserved ejection fraction （HF-PEF）, and to evaluate the impact of systolic dyssynchrony on left ventricular function.
Methods During June 2011 to May 2014, a total of 352 patients（160 males, 192 females, average age： （67.6±7.8）years） with essential hypertension （EH） were enrolled in this retrospective study. Ultrasonic and G-MPI were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by one-way analysis of variance and χ^2 test. Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis.Results The EH patients were divided into hypertension group （n=182）, LVH group （n=74） and HF-PEF group （n=96）. In comparison to hypertension group, significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved. The LVMI of the 3 groups were （94.4±10.1）, （121.1±9.8） and （123.2±10.9） g/m2, respectively（F=8.66, P〈0.05）. The LVEF was （58.6±7.3）%, （60.8±10.4）% and （55.1±4.6）%, respectively（F=2.89, P〉0.05）. Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio （1.19±0.23, 0.80±0.28, 0.67±0.17; F=13.46, P〈0.05）. Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth （PHB） of （88.4±8.6）° and phase standard deviation （PSD） of （23.6±1.9）° and increased BNP of （228.4±69.7） ng/L were revealed in HF-PEF group. The BNP in HF-PEF group was significantly higher than that in LVH group（（92.5±13.6） ng/L; q=8.63, P〈0.05）. Positive correlation was found between BNP level and PHB, PSD, LVMI, respectively （r=0.277-0.331, all P〈0.05）.Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH, and this dyssynchrony might be one of the factors leading to diastolic dysfunction.
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2016年第2期161-165,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
