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目的探讨多普勒超声指标心肌能量消耗(MEE)评估原发性高血压不同左室构型特点以及左室收缩功能的潜在临床价值。方法选取门诊或住院治疗的106例原发性高血压患者,24例健康人为对照组。用多普勒超声心动图测量心脏结构指标、左室收缩功能常规指标(射血分数、短轴缩短率),应用相关公式计算MEE、左室收缩末周向室壁应力(cESS)、左室质量指数(LVMI)、相对室壁厚度(RWT)。根据LVMI和RWT将高血压患者分为左室正常构型组(22例)、向心性重构组(34例)、向心性肥厚组(26例)和离心性肥厚组(24例);分析各组间左室结构、功能的差异,探讨MEE、cESS与左室结构、功能指标的相关性。结果高血压4组cESS均明显高于对照组,其中离心性肥厚组最高;除向心性重构组外,其余高血压3组MEE均明显高于对照组(均P<0.05),离心性肥厚组MEE最高。相关分析显示:MEE、cESS与左室收缩功能指标以及左心室重构指标均明显相关。结论多普勒超声心动图无创检测原发性高血压患者的MEE水平可反映高血压左室不同构型的心肌生物能量消耗特点;MEE、cESS是评价高血压不同构型左室收缩功能的有效指标。
Objective To investigate the clinical value of Doppler echocardiographic myocardial energy expenditure (MEE) in assessing the characteristics of different left ventricular configurations and left ventricular systolic function in patients with essential hypertension. Methods Outpatient or inpatient treatment of 106 cases of essential hypertension, 24 healthy people as the control group. Doppler echocardiography was used to measure cardiac structural parameters, left ventricular systolic function index (ejection fraction, short axis shortening rate), the correlation formula was used to calculate the MEE, left ventricular end systolic circumferential wall stress (cESS), left ventricular Quality Index (LVMI), Relative Wall Thickness (RWT). According to LVMI and RWT, hypertension patients were divided into normal left ventricular group (n = 22), concentric remodeling group (n = 34), concentric hypertrophy group (n = 26) and eccentric hypertrophy group The left ventricular structure and function differences between groups, to explore the MEE, cESS and left ventricular structure and function of the correlation. Results The levels of cESS in hypertension group were significantly higher than those in control group, with the highest in eccentric hypertrophy group. MEE in the other three groups were significantly higher than those in control group (all P <0.05) Group MEE highest. Correlation analysis showed that: MEE, cESS and left ventricular systolic function index and left ventricular remodeling indicators were significantly related. Conclusions The noninvasive detection of MEE in patients with essential hypertension by Doppler echocardiography can reflect the myocardial bioenergetic energy expenditure of different configurations of left ventricular hypertrophy. MEE and cESS are effective in assessing left ventricular systolic function in different configurations of hypertension index.