论文部分内容阅读
的 探讨心电图左室高电压对评估高血压心肌微血管病变的价值。方法 应用心肌对比超声心动图 ,静注微泡造影剂 (全氟显 )后 ,采用间断谐波成像技术测量静息时和注射双嘧达莫后心肌的A、β和A·β,并计算出A、β比值和冠脉微血管的血流储备 (CMVFR)。 结果 与对照组相比 ,高血压伴心电图左室高电压患者静息时的A、β和A·β值均增高 ;而应用双嘧达莫后左室高电压和无左室高电压组增加的幅度明显减少 ,A、β比值、β比值以及CMVFR显著降低。其中左室高电压者降低更明显 ;随着高血压病情的加重 ,A、β值逐渐增高 ,A比值、β比值和CMVFR逐渐下降 ,A、β和A·β值与RV5、SV1、RV5+SV1、SBP、DBP显著正相关 (P<0 .0 5和 0 .0 1) ,CMVFR与SV1和DBP显著负相关 (P <0 .0 1)。结论 高血压患者的静息心肌微循环血流量增加、心肌微血管储备和非内皮依赖性的血管扩张能力明显受损 ,心肌毛细血管密度明显减少 ,并且随着疾病的进展而加重 ;高血压LVH患者较无LVH者的心肌微血管功能受损程度更严重 ;高血压患者如果合并心电图左室高电压时 ,应考虑存在心肌微血管病变的可能性 ;MCE对诊断高血压微血管疾病有着良好的应用前景。
To investigate the value of ECG left ventricular high voltage in the assessment of myocardial microvascular disease of hypertension. Methods After myocardial contrast echocardiography and intravenous injection of microbubble contrast medium (perfluorinated), the A, β and A · β of myocardium at rest and after injection of dipyridamole were measured by discontinuous harmonic imaging and calculated A, β ratio and coronary microvascular blood flow reserve (CMVFR). Results Compared with the control group, the values of A, β and A · β increased at rest in patients with hypertension and left ventricular hypertrophy with ECG, while those with left ventricular hypertrophy and without left ventricular hypertension increased with dipyridamole Significantly reduced the amplitude, A, β ratio, β ratio and CMVFR significantly decreased. The levels of A, β increased gradually, while the ratio of A, β and CMVFR decreased gradually. The values of A, β and A · β were positively correlated with RV5, SV1, RV5 + SV1, SBP and DBP were significantly and positively correlated (P <0.05 and 0.01), CMVFR was significantly and negatively correlated with SV1 and DBP (P <0.01). Conclusions Hypertensive patients with increased myocardial blood flow, myocardial microvascular reserve and non-endothelium-dependent vasodilatation were significantly impaired, myocardial capillary density was significantly reduced, and aggravated with the progress of the disease; hypertension in patients with LVH Compared with those without LVH, the damage of myocardial microvascular function is more serious. The possibility of myocardial microangiopathy should be considered in hypertensive patients with left ventricular hypertrophy, and MCE has good application prospect in diagnosing hypertensive microangiopathy.