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-MP1 were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by oneway analysis of variance and x2 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 (rt =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.%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、x2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/m2,显著高于单纯高血压组的(94.4±10.1)g/m2(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.
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