目的应用二维应变成像检测原发性高血压左心室构型正常患者心肌应变,并探讨其临床意义.方法选择左心室构型正常的原发性高血压患者70例和健康志愿者30例(健康对照组),原发性高血压患者中左心室舒张充盈正常者(左心室舒张充盈正常组)35例,松弛性减低者(左心室松弛性减低组)35例.采集心尖四腔心切面、二腔心切面、左心室长轴切面及胸骨旁乳头肌水平左心室短轴切面的二维灰阶动态图像.应用二维应变成像测量左心室纵向、圆周、径向应变率.结果健康对照组、左心室舒张充盈正常组、左心室松弛性减低组收缩期纵向峰值应变率分别为(-1.4±0.2)s-1、(-1.4±0.2)s-1、(-1.2±0.2) s-1,组间比较差异有统计学意义(F=11.38,P=0.00),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=5.68、5.92,P均<0.01).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组舒张早期纵向峰值应变率分别为(2.9±0.4)s-1、(2.6±0.3)s-1、(2.3±0.4)s-1,组间比较差异有统计学意义(F=21.51,P=0.00),且左心室舒张充盈正常组、左心室松弛性减低组与健康对照组比较,差异均有统计学意义(q=4.63、9.27,P均<0.01),左心室舒张充盈正常组与左心室松弛性减低组比较,差异有统计学意义(q=4.82, P<0.01).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组心房收缩期纵向峰值应变率分别为(1.2±0.2)s-1、(1.2±0.2)s-1、(1.4±0.2) s-1,组间比较差异有统计学意义(F=11.38,P=0.00),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=5.68、5.92,P均<0.01).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组收缩期圆周峰值应变率分别为(-1.4±0.4)s-1、(-1.5±0.3)s-1、(-1.8±0.4) s-1,组间比较差异有统计学意义(F=10.66,P=0.00),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=6.18、4.82,P均<0.01).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组舒张早期圆周峰值应变率分别为(2.0±0.4)s-1、(2.0±0.5)s-1、(1.8±0.5)s-1,组间比较差异无统计学意义(F=2.04,P=0.14).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组心房收缩期圆周峰值应变率分别为(1.1±0.3)s-1、(1.0±0.3)s-1、(1.4±0.4)s-1,组间比较差异有统计学意义(F=13.14,P=0.00),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=5.04、6.99,P均<0.01).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组收缩期径向峰值应变率分别为(2.6±0.6)s-1、(2.6±0.7)s-1、(2.4±0.7) s-1,组间比较差异无统计学意义(F=1.01,P=0.37).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组舒张早期径向峰值应变率分别为(-2.7±0.7)s-1、(-2.7±0.9)s-1、(-2.2±0.7)s-1,组间比较差异有统计学意义(F=4.72,P=0.01),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=3.66、3.81,P均<0.05).健康对照组、左心室舒张充盈正常组、左心室松弛性减低组心房收缩期径向峰值应变率分别为(-1.3±0.9)s-1、(-1.4±0.5)s-1、(-1.8± 0.8)s-1,组间比较差异有统计学意义(F=3.96,P=0.02),且左心室松弛性减低组与健康对照组、左心室舒张充盈正常组比较,差异均有统计学意义(q=3.69、3.07,P均<0.05).结论原发性高血压患者左心室纵向舒张与收缩功能受损早于左心室构型改变.收缩期圆周方向及心房收缩期心肌应变增加代偿性保证左心室泵功能及充盈量处于正常水平.二维应变成像可定量检测左心室心肌应变,准确评价原发性高血压患者左心室心肌功能的早期改变.
目的應用二維應變成像檢測原髮性高血壓左心室構型正常患者心肌應變,併探討其臨床意義.方法選擇左心室構型正常的原髮性高血壓患者70例和健康誌願者30例(健康對照組),原髮性高血壓患者中左心室舒張充盈正常者(左心室舒張充盈正常組)35例,鬆弛性減低者(左心室鬆弛性減低組)35例.採集心尖四腔心切麵、二腔心切麵、左心室長軸切麵及胸骨徬乳頭肌水平左心室短軸切麵的二維灰階動態圖像.應用二維應變成像測量左心室縱嚮、圓週、徑嚮應變率.結果健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組收縮期縱嚮峰值應變率分彆為(-1.4±0.2)s-1、(-1.4±0.2)s-1、(-1.2±0.2) s-1,組間比較差異有統計學意義(F=11.38,P=0.00),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=5.68、5.92,P均<0.01).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組舒張早期縱嚮峰值應變率分彆為(2.9±0.4)s-1、(2.6±0.3)s-1、(2.3±0.4)s-1,組間比較差異有統計學意義(F=21.51,P=0.00),且左心室舒張充盈正常組、左心室鬆弛性減低組與健康對照組比較,差異均有統計學意義(q=4.63、9.27,P均<0.01),左心室舒張充盈正常組與左心室鬆弛性減低組比較,差異有統計學意義(q=4.82, P<0.01).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組心房收縮期縱嚮峰值應變率分彆為(1.2±0.2)s-1、(1.2±0.2)s-1、(1.4±0.2) s-1,組間比較差異有統計學意義(F=11.38,P=0.00),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=5.68、5.92,P均<0.01).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組收縮期圓週峰值應變率分彆為(-1.4±0.4)s-1、(-1.5±0.3)s-1、(-1.8±0.4) s-1,組間比較差異有統計學意義(F=10.66,P=0.00),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=6.18、4.82,P均<0.01).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組舒張早期圓週峰值應變率分彆為(2.0±0.4)s-1、(2.0±0.5)s-1、(1.8±0.5)s-1,組間比較差異無統計學意義(F=2.04,P=0.14).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組心房收縮期圓週峰值應變率分彆為(1.1±0.3)s-1、(1.0±0.3)s-1、(1.4±0.4)s-1,組間比較差異有統計學意義(F=13.14,P=0.00),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=5.04、6.99,P均<0.01).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組收縮期徑嚮峰值應變率分彆為(2.6±0.6)s-1、(2.6±0.7)s-1、(2.4±0.7) s-1,組間比較差異無統計學意義(F=1.01,P=0.37).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組舒張早期徑嚮峰值應變率分彆為(-2.7±0.7)s-1、(-2.7±0.9)s-1、(-2.2±0.7)s-1,組間比較差異有統計學意義(F=4.72,P=0.01),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=3.66、3.81,P均<0.05).健康對照組、左心室舒張充盈正常組、左心室鬆弛性減低組心房收縮期徑嚮峰值應變率分彆為(-1.3±0.9)s-1、(-1.4±0.5)s-1、(-1.8± 0.8)s-1,組間比較差異有統計學意義(F=3.96,P=0.02),且左心室鬆弛性減低組與健康對照組、左心室舒張充盈正常組比較,差異均有統計學意義(q=3.69、3.07,P均<0.05).結論原髮性高血壓患者左心室縱嚮舒張與收縮功能受損早于左心室構型改變.收縮期圓週方嚮及心房收縮期心肌應變增加代償性保證左心室泵功能及充盈量處于正常水平.二維應變成像可定量檢測左心室心肌應變,準確評價原髮性高血壓患者左心室心肌功能的早期改變.
목적응용이유응변성상검측원발성고혈압좌심실구형정상환자심기응변,병탐토기림상의의.방법선택좌심실구형정상적원발성고혈압환자70례화건강지원자30례(건강대조조),원발성고혈압환자중좌심실서장충영정상자(좌심실서장충영정상조)35례,송이성감저자(좌심실송이성감저조)35례.채집심첨사강심절면、이강심절면、좌심실장축절면급흉골방유두기수평좌심실단축절면적이유회계동태도상.응용이유응변성상측량좌심실종향、원주、경향응변솔.결과건강대조조、좌심실서장충영정상조、좌심실송이성감저조수축기종향봉치응변솔분별위(-1.4±0.2)s-1、(-1.4±0.2)s-1、(-1.2±0.2) s-1,조간비교차이유통계학의의(F=11.38,P=0.00),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=5.68、5.92,P균<0.01).건강대조조、좌심실서장충영정상조、좌심실송이성감저조서장조기종향봉치응변솔분별위(2.9±0.4)s-1、(2.6±0.3)s-1、(2.3±0.4)s-1,조간비교차이유통계학의의(F=21.51,P=0.00),차좌심실서장충영정상조、좌심실송이성감저조여건강대조조비교,차이균유통계학의의(q=4.63、9.27,P균<0.01),좌심실서장충영정상조여좌심실송이성감저조비교,차이유통계학의의(q=4.82, P<0.01).건강대조조、좌심실서장충영정상조、좌심실송이성감저조심방수축기종향봉치응변솔분별위(1.2±0.2)s-1、(1.2±0.2)s-1、(1.4±0.2) s-1,조간비교차이유통계학의의(F=11.38,P=0.00),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=5.68、5.92,P균<0.01).건강대조조、좌심실서장충영정상조、좌심실송이성감저조수축기원주봉치응변솔분별위(-1.4±0.4)s-1、(-1.5±0.3)s-1、(-1.8±0.4) s-1,조간비교차이유통계학의의(F=10.66,P=0.00),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=6.18、4.82,P균<0.01).건강대조조、좌심실서장충영정상조、좌심실송이성감저조서장조기원주봉치응변솔분별위(2.0±0.4)s-1、(2.0±0.5)s-1、(1.8±0.5)s-1,조간비교차이무통계학의의(F=2.04,P=0.14).건강대조조、좌심실서장충영정상조、좌심실송이성감저조심방수축기원주봉치응변솔분별위(1.1±0.3)s-1、(1.0±0.3)s-1、(1.4±0.4)s-1,조간비교차이유통계학의의(F=13.14,P=0.00),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=5.04、6.99,P균<0.01).건강대조조、좌심실서장충영정상조、좌심실송이성감저조수축기경향봉치응변솔분별위(2.6±0.6)s-1、(2.6±0.7)s-1、(2.4±0.7) s-1,조간비교차이무통계학의의(F=1.01,P=0.37).건강대조조、좌심실서장충영정상조、좌심실송이성감저조서장조기경향봉치응변솔분별위(-2.7±0.7)s-1、(-2.7±0.9)s-1、(-2.2±0.7)s-1,조간비교차이유통계학의의(F=4.72,P=0.01),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=3.66、3.81,P균<0.05).건강대조조、좌심실서장충영정상조、좌심실송이성감저조심방수축기경향봉치응변솔분별위(-1.3±0.9)s-1、(-1.4±0.5)s-1、(-1.8± 0.8)s-1,조간비교차이유통계학의의(F=3.96,P=0.02),차좌심실송이성감저조여건강대조조、좌심실서장충영정상조비교,차이균유통계학의의(q=3.69、3.07,P균<0.05).결론원발성고혈압환자좌심실종향서장여수축공능수손조우좌심실구형개변.수축기원주방향급심방수축기심기응변증가대상성보증좌심실빙공능급충영량처우정상수평.이유응변성상가정량검측좌심실심기응변,준학평개원발성고혈압환자좌심실심기공능적조기개변.
Objective To evaluate the value of two dimensional strain imaging in assessing left ventricular myocardium strain in patients with essential hypertension and normal left ventricular geometry . Methods Thirty normal subjects and seventy patients with essential hypertension with normal left ventricular geometry were enrolled , including 35 cases with normal filling and 35 cases with abnormal relaxation.The longitudinal strain rate curves were determined in apical 2-chamber views,4-chamber views and long-axis of left ventricle views.Radial and circumferential strain rate curves were determined in the parasternal short-axis views at the level of the papillary muscles .Results The mean peak systolic longitudinal strain rate were (-1.4 ±0.2) s-1 ,( -1.4 ±0.2)s-1 ,( -1.2 ±0.2)s-1 in normal control group,normal filling group and abnormal relaxation group respectively ,with significant differences among the groups(F=11.38,P =0.00).The significant differences were identified in following comparisons:group normal control/normal filling with abnormal relaxation group (q=5.68,5.92,both P<0.01).The mean peak early diastolic longitudinal strain rate were (2.9 ±0.4) s-1 ,(2.6 ±0.3) s-1 ,(2.3 ±0.4) s-1 in normal control group,normal filling group and abnormal relaxation group respectively .There were significant differences among the groups (F=21.51,P=0.00).The significant differences were identified in following comparisons:group normal filling/abnormal relaxation group with normal control group (q=4.63,9.27,both P<0.01),normal filling group with abnormal relaxation group (q=4.82,P<0.01).The mean peak LV systolic longitudinal strain rate during atrial systole were (1.2 ±0.2)s-1 ,(1.2 ±0.2)s-1 ,(1.4 ±0.2)s-1 in normal control group,normal filling group and abnormal relaxation group respectively .There were significant differences among the groups (F=11.38,P=0.00).In detail,the significant differences were identified in following comparisons:group normal control/normal filling with abnormal relaxation group (q=5.68,5.92, both P<0.01).The mean peak systolic circumferential strain rate were (-1.4 ±0.4)s-1 ,(-1.5 ±0.3)s-1 , (-1.8 ±0.4)s-1 in normal control group,normal filling group and abnormal relaxation group respectively , with significant differences among the groups ( F =10.66, P =0.00).The significant differences were identified in following comparisons:abnormal relaxation group with normal control (q=4.15,P<0.05).The mean peak early diastolic circumferential strain rate were (2.0 ±0.4)s-1 ,(2.0 ±0.5)s-1 ,(1.8 ±0.5) s-1 in normal control group,normal filling group and abnormal relaxation group respectively ,with no significant differences among the groups (F=2.04,P=0.14).The mean peak circumferential strain rate during atrial systole were(1.1 ±0.3)s-1 ,(1.0 ±0.3)s-1 ,(1.4 ±0.4) s-1 in normal control group,normal filling group and abnormal relaxation group respectively , with significant differences among the groups ( F =13.14, P=0.00).In detail, the significant differences were identified in following comparisons:group normal control/normal filling with abnormal relaxation group ( q =5.04,6.99,both P <0.01).The mean peak systolic radial strain rate were (2.6 ±0.6)s-1 ,(2.6 ±0.7)s-1 ,(2.4 ±0.7)s-1 in normal control group, normal filling group and abnormal relaxation group respectively .There were no significant differences among the groups(F=1.01,P=0.37).The mean peak early diastolic radial strain rate were ( -2.7 ±0.7)s-1 , (-2.7 ±0.9)s-1 ,(-2.2 ±0.7)s-1 in normal control group,normal filling group and abnormal relaxation group respectively,with significant differences among the groups ( F =4.72, P =0.01).The significant differences were identified in following comparisons:group normal control/normal filling with abnormal relaxation group(q=3.66,3.81,both P<0.05).The mean peak circumferential strain rate during atrial systole were (-1.3 ±0.9)s-1 ,( -1.4 ±0.5) s-1 ,( -1.8 ±0.8) s-1 in normal control group,normal filling group and abnormal relaxation group respectively .There were significant differences among the groups (F=3.96,P=0.02).In detail,the significant differences were identified in following comparisons:group normal control/normal filling with abnormal relaxation group (q=3.69,3.07,both P<0.05).Conclusions LV myocardial contraction and relaxation were first impaired in the longitudinal direction among the 3 directions in EH patients with normal left ventricular geometry .However,LV pump function and LV filling were compensated by circumferential shortening at ventricular systole and 3 directional lengthenings at atrial systole,respectively.Two-dimension strain imaging can quantify left ventricular myocardium strain and assess early alteration of left ventricular function correctly in patients with EH .
