高血压病患者左心室构型的彩色多普勒超声分析

摘要

Objective　To analyze the patterns of left ventricular geometry and their mechanism of development in hypertensive patient.Methods　The left ventricular mass index (LVMI) and relative wall thickness (RWT) were determined by echocardiography in 172 essential hypertensive patients and 123 normal control subjects. Whether mitral and /or aortic regurgitation exists and their severities were evaluated by color Doppler echocardiography. Also the systemic vascular resistance (SVR) was calculated by brachial blood pressure and the cardiac output determined by echocardiography in all patients and normal subjects. Different left ventricular geometric patterns were analyzed according to LVMI and RWT, together with their color Doppler echocardiographic findings and SVR features.Results　There were four left ventricular geometric patterns in 172 hypertensive patients. Among them 49.42% had normal left ventricular geometric pattern, 9.30% had concentric remodeling of left ventricle, 11.63% concentric and 29.65% eccentric left ventricular hypertrophy. Moderate mitral regurgitation was more common in eccentric left ventricular hypertrophy group. While SVR was the highest in the concentric remodeling group and also high in concentric left ventricular hypertrophy and normal left ventricular group in sequence. The SVR value of these three groups in comparing to control group had significant difference (P<0.01).Conclusions　In hypertensive patients, eccentric left ventricular hypertrophy is more common than concentric left ventricular hypertrophy, and left ventricular concentric remodeling also ocurrs in a certain proportion. Concentric left ventricular hypertrophy and concentric left ventricular remodeling are primarily related to the pressure overload, while eccentric left ventricular hypertrophy is related both to pressure and volume overload. Concentric remodeling of left ventricle may also be related to volume underload.%目的　分析高血压病患者左心室的不同构型及其发生机制。方法　高血压病组172例，对照组123例，以超声心动图测定左心室重量指数（LVMI）和室壁相对厚度（RWT）；以彩色多普勒检测有无二尖瓣或主动脉瓣反流及其程度；以肱动脉血压和左心排血量计算体循环血管阻力（SVR）。根据LVMI与RWT 分析高血压病患者的左心室不同构型，并分析其彩色多普勒超声表现与SVR特征。结果　高血压病组左室正常型占49.42%，向心性重构型9.30%，向心性肥厚型11.63%，离心性肥厚型29.65%。离心性肥厚组中度二尖瓣反流者较多。SVR最高者为向心性重构组，其次为向心性肥厚组，再次为左室正常组，三者与对照组比较差异均有显著意义（P<0.01）。结论　在高血压病患者中，离心性肥厚较向心性肥厚更为常见，向心性重构也占一定的比例。向心性肥厚及向心性重构主要与压力负荷过重有关;离心性肥厚既有压力负荷过重，又有容量负荷过重；向心性重构还可能与容量低负荷有关。