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目的分析老年左室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HF-PEF)患者超声心动图指标水平变化,评价超声心动图在HF-PEF诊断中的价值。方法年龄≥65岁的HF-PEF患者60例(HF-PEF组),同期住院有胸闷症状、左室射血分数及N-末端脑钠肽前体正常的非心力衰竭患者31例为对照组,测定2组超声心动图指标并进行比较。结果 HF-PEF组左心房内径[(46.58±6.43)mm]、右心房内径[(40.95±6.54)mm]、右心室内径[(34.12±5.49)mm]、肺动脉收缩压[(37.82±9.02)mm Hg]、二尖瓣舒张早期最大血流速度E峰[(90.77±29.36)cm/s]、E峰与二尖瓣环室间隔及左室侧壁组织舒张早期最大运动速度(Ea)比值(E/Ea)(13.93±7.49)、收缩期肺静脉血流速度(S)与舒张早期肺静脉血流速度(D)比值(S/D)<0.5比例(21.67%)、三尖瓣中度以上反流比例(26.67%)、二尖瓣中度以上反流比例(33.33%)高于对照组[(40.58±5.67)mm、(35.90±4.20)mm、(30.81±5.29)mm、(30.13±6.90)mm Hg、(68.15±25.02)cm/s、10.72±4.11、3.23%、3.23%、6.45%],二尖瓣E峰减速时间[(195.81±69.91)ms]较对照组[(238.48±76.67)ms]短,差异均有统计学意义(P<0.05);2组左室射血分数、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、左心室相对室壁厚度、主动脉瓣反流比例比较差异均无统计学意义(P>0.05)。结论左心房增大,E峰及E/Ea比值增高,心脏瓣膜反流增加、肺动脉收缩压增高,以及右心功能改变是老年HF-PEF患者常见的超声心动图表现。
Objective To analyze the changes of echocardiographic parameters in elderly patients with heart failure with preserved ejection fraction (HF-PEF) and to evaluate the value of echocardiography in the diagnosis of HF-PEF. Methods Sixty HF-PEF patients aged ≥65 years (HF-PEF group), 31 cases of hospitalized patients with chest distress, left ventricular ejection fraction and normal non-cardiac N-terminal pro brain natriuretic peptide in control group , Two groups of echocardiography indicators were measured and compared. Results The left atrial diameter [(46.58 ± 6.43) mm], the diameter of the right atrium (40.95 ± 6.54) mm, the diameter of the right ventricle (34.12 ± 5.49) mm and the systolic pressure of the pulmonary artery [(37.82 ± 9.02) mm Hg], E peak peak velocity of mitral early diastolic velocity [(90.77 ± 29.36) cm / s], E peak and mitral annular interventricular septum and left ventricular early diastolic velocity (Ea) (E / Ea) (13.93 ± 7.49), systolic pulmonary venous velocity (S) and early diastolic pulmonary venous flow velocity (D) ratio <0.5 (21.67% The reflux ratio (26.67%) was higher than that of the control group (40.58 ± 5.67) mm, (35.90 ± 4.20) mm, (30.81 ± 5.29) mm and (30.13 ± 6.95) mmHg, (68.15 ± 25.02) cm / s, 10.72 ± 4.11,3.23%, 3.23% and 6.45%, respectively]. The deceleration time of mitral E peak was (195.81 ± 69.91) 76.67) ms] short and the differences were statistically significant (P <0.05). The left ventricular ejection fraction, the left ventricular end-diastolic dimension, the thickness of the ventricular septum, the thickness of the left ventricular posterior wall, There was no significant difference in the proportion of aortic regurgitation (P> 0.05). Conclusion The increase of left atrium, the increase of E peak and E / Ea ratio, the increase of heart valve regurgitation, the increase of pulmonary artery systolic pressure, and the change of right heart function are common echocardiographic findings in elderly patients with HF-PEF.