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超声心动图及应变显像技术对高血压合并初发心房颤动患者的评估价值

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目的 研究超声心动图和应变显像技术评估高血压并发初发心房颤动(房颤)患者心脏
结构及功能改变的价值。方法 入选2017年1月至2018年12月于解放军总医院第七医学中心收治的原发
性高血压患者93例,其中单纯性高血压患者49例(EH组)、合并初发阵发性房颤患者44例(EH-AF
组)。所有患者行常规超声心动图检测,记录左心房内径(LAD)、左心房最大容积(LAVmax)、左
心房最小容积(LAVmin)、左心室心肌质量(LVM),计算左心室心肌质量指数(LVMI)、左心房容
积指数(LAVI)和左心房总排空分数(LATEF)。应用应变显像技术获取左心房纵向应变曲线,记录
房壁各节段收缩期峰值应变及应变率(SSL、SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变
率(SRa),计算其平均值,比较两组患者常规超声指标及应变显像技术指标之间的差异。结果 EHAF
组LAVI和LVMI较EH组升高,分别为[(39.6±11.5)ml/m2 vs.(29.2±9.1)ml/m2]和 [(126.6±20.3)
g/m2 vs. (108.7±14.9)g/m2] 。EH-AF组LATEF较EH组减低。EH-AF组mSSL和mSRs较EH组降低,分别
为[(32.23±6.25)% vs. (40.67±6.52)%]和 [(0.96±0.38)s-1 vs.(1.63±0.59)s-1];EH-AF组mSRe和
mSRa较EH组减低,分别为[(-1.03±0.33)s-1 vs.(-1.38±0.46)s-1]和[(-0.62±0.29)s-1 vs. (-1.75±
0.51)s-1]。差异具有统计学意义(P均<0.05)。结论 高血压合并初发房颤患者较单纯高血压患者左心
房容积指数、左心室心肌质量指数升高、左心房总排空分数降低、左心房应变值下降,超声心动图和应
变显像技术对评估高血压并发初发房颤患者心脏结构及功能方面具有一定的价值。

Abstract:

Objective To study the value of echocardiography and strain imaging technique in reviewing the
changes of heart structure and function in patients with hypertension complicated by incipient atrial fibrillation (AF).
Methods The patients with essential hypertension (EH, n=93) were chosen from the Seventh Medical Center of
Chinese PLA General Hospital from Jan. 2017 to Dec. 2018, and divided into EH group (n=49) and EH-AF group
(n=44). All patients were given routine detection of echocardiography, and left atrial diameter (LAD), maximum left
atrial volume (LAVmax), minimum left atrial volume (LAVmin) and left ventricle mass (LVM) were recorded, and
left ventricle mass index (LVMI), left atrial volume index (LAVI) and left atrial total ejection fraction (LATEF) were
calculated. The left atrial longitudinal strain curve, and peak systolic strain and strain rate (SSL, SRs), peak early
diastolic stain rate (SRe) and peak late diastolic strain rate (SRa) of different segments of LA wall were obtained
and recorded and the mean value was calculated by using strain imaging technique. The differences in routine
ultrasound indexes and indicators of strain imaging technique were compared between 2 groups. Results In H-AF
group, LAVI [(39.6±11.5) ml/m2 vs. (29.2±9.1) ml/m2] and LVMI [(126.6±20.3) g/m2 vs. (108.7±14.9) g/m2] were
higher than those in EH group. LATEF decreased in EH-AF group compared with EH group. In H-AF group,
mSSL [(32.23±6.25) % vs. (40.67±6.52) %] and mSRs [(0.96±0.38) s-1 vs. (1.63±0.59) s-1] were lower than
those in EH group. In H-AF group, mSRe [(-1.03±0.33) s-1 vs. (-1.38±0.46) s-1] and mSRa [(-0.62±0.29) s-1 vs.
(-1.75±0.51) s-1] were lower than those in EH group (all P<0.05). Conclusion In the patients with hypertension
complicated by incipient AF, the left atrial volume and LVMI increase, and LATEF and left atrial strain value
decrease compared with patients with only hypertension. Echocardiography and strain imaging technique have some
value in reviewing heart structure and function in patients with hypertension complicated by incipient AF.

基金项目:

军队保健专项科研课题(15BJZ03)

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