实时三维超声心动图联合三维斑点追踪成像评估不同程度高血压患者左心功能变化的临床研究OA
Clinical study of real-time three-dimensional echocardiography combined with three-dimensional speckle tracking imaging to evaluate the changes of left heart function in patients with different degrees of hypertension
目的:探讨实时三维超声心动图(RT-3DE)联合三维斑点追踪成像(3D-STI)评估不同程度高血压患者左心功能变化的临床应用价值.方法:回顾选取2024年1月—2025年8月苏州市立医院收治的高血压患者150例,根据高血压等级标准分为Ⅰ级组51例、Ⅱ级组57例与Ⅲ级组42例,另选取同期年龄、性别相匹配的健康体检者50例作为对照组.比较各组间常规超声心动图、RT-3DE(左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、3D左心室射血分数(3D-LVEF)、左心房主动射血分数(LAAEF)、左心房被动射血分数(LAPEF)、左心房最大容积指数(LAVImax))及3D-STI(左心室整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)、整体面积应变(GAS)、左心房储备期应变(LASr)、左心房管道期应变(LAScd)、左心房收缩期应变(LASct))参数的差异,分析其与高血压分级的相关性,采用多元线性回归筛选高血压分级的独立预测因子.结果:LVEDV、LVESV、LAVImax、LVMI、E/e'比较,对照组<Ⅰ级组<Ⅱ级组<Ⅲ级组,LVPWT、IVST比较,Ⅰ级组<Ⅱ级组<Ⅲ级组,LAPEF、LAEF、LAAEF、GLS、GAS、LASr、LAScd、LASct比较,对照组>Ⅰ级组>Ⅱ级组>Ⅲ级组,3D-LVEF比较,Ⅰ级组>Ⅱ级组>Ⅲ级组(P<0.05);Ⅲ级组LVEDd高于Ⅰ级组及对照组,2D-LVEF低于Ⅰ级组及对照组,GCS、GRS低于对照组(P<0.05);Spearman相关性分析显示,高血压分级与GLS、GAS、LASr、LAScd、LASct、LAPEF、3D-LVEF、E/A、LAEF、LAAEF呈负相关,与LVEDV、LVESV、LAVImax、LVMI、E/e'呈正相关(P<0.05).多元线性回归分析显示3D-LVEF、LVMI、GLS、LASr、LAPEF、E/e'是高血压分级的独立预测因子(P<0.05).结论:RT-3DE及3D-STI能够定量评估高血压患者左心功能的渐进性损害过程,二者联合应用可为高血压心脏病的早期诊断、危险分层提供影像学依据.
Objective:To investigate the clinical value of real-time three-dimensional echocardiography(RT-3DE)com-bined with three-dimensional speckle tracking imaging(3D-STI)in evaluating the changes of left atrial and ventricular func-tion in patients with different degrees of hypertension.Methods:A total of 150 patients with hypertension admitted to Suzhou Municipal Hospital from January 2024 to August 2025 were retrospectively selected.According to the standard of hypertension grade,they were divided into grade Ⅰ group(51 cases),grade Ⅱ group(57 cases)and grade Ⅲ group(42 cases).In addition,50 healthy subjects with matching age and gender were selected as the control group.The parameters of con-ventional echocardiography,RT-3DE(left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),3D left ventricular ejection fraction(3D-LVEF),left atrial active ejection fraction(LAAEF),left atrial passive ejec-tion fraction(LAPEF),left atrial maximum volume index(LAVImax))and 3D-STI(left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),global area strain(GAS),left atrial reservoir strain(LASr),left atrial conduit strain(LAScd),left atrial systolic strain(LASct))were compared among the groups.The correlation with hypertension grade was analyzed,and the independent predictors of hypertension grade were screened by multiple linear regression.Results:Comparison of LVEDV,LVESV,LAVImax,LVMI,E/e',control group<grade Ⅰ group<grade Ⅱ group<grade Ⅲ group,comparison of LVPWT,IVST grade Ⅰ group<grade Ⅱ group<grade Ⅲ group,comparison of LAPEF,LAEF,LAAEF,GLS,GAS,LASr,LAScd,LASct,control group>grade Ⅰ group>grade Ⅱ group>grade Ⅲ group,comparison of 3D-LVEF,grade Ⅰ group>grade Ⅱ group>grade Ⅲ group(P<0.05);LVEDd in grade Ⅲ group was higher than that in grade Ⅰ group and control group,2D-LVEF was lower than that in grade Ⅰ group and control group,GCS and GRS were lower than those in control group(P<0.05).Spearman correlation analysis showed that hypertension grade was negatively corre-lated with GLS,GAS,LASr,LAScd,LASct,LAPEF,3D-LVEF,E/A,LAEF and LAAEF,and positively correlated with LVEDV,LVESV,LAVImax,LVMI and E/e'(P<0.05).Multiple linear regression analysis showed that 3D-LVEF,LVMI,GLS,LASr,LAPEF and E/e'were independent predictors of hypertension grade(P<0.05).Conclusion:RT-3DE and 3D-STI can quantitatively evaluate the progressive damage process of left ventricular function in patients with hypertension.The com-bined application of RT-3DE and 3D-STI can provide imaging basis for early diagnosis and risk stratification of hyperten-sive heart disease.
徐凤兰;秦玲玲;刘坦;钟佳琪;苟中山;王汸
苏州市立医院,江苏 苏州 215000苏州市立医院,江苏 苏州 215000苏州市立医院,江苏 苏州 215000苏州市立医院,江苏 苏州 215000苏州市立医院,江苏 苏州 215000苏州市立医院,江苏 苏州 215000
医药卫生
高血压心室功能,左超声心动描记术
HypertensionVentricular Function,LeftEchocardiography
《中国临床医学影像杂志》 2026 (9)
640-644,649,6
苏州市应用基础研究科技创新指导性项目(SYWD2024009).
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