目的 探讨高血压病患者左室整体结构和功能异常前是否已存在局部心肌功能异常及其临床意义.方法 年龄30～70岁的30例健康人和54例左室整体结构和功能正常的高血压病患者分别入选对照组和高血压组.应用超声应变率成像技术检测左室心肌长轴各节段收缩期、舒张早期、房缩期峰值应变率(SRs、Sre、Sra)和收缩-舒张转换时间(Tcec),分析其与左房内径指数(LADI)、左房面积指数(LAAI)的相关性.结果 与对照组比较,高血压组前壁基底部SRs,间壁基底、中段和整壁,侧壁基底和整壁,下壁整壁,前壁基底段Sre明显减低;间壁和前壁各段及整壁Sra明显增高;各壁Sre/a异常率(Sre/Sra＜1节段所占该壁总节段数的百分率)均明显增高;间壁各段及整壁,侧壁和前壁的基底、中间段及整壁的Tcec明显延长.高血压组间壁各节段、侧壁心尖段、间壁和侧壁平均Tcec以及侧壁中段Sra与LADI呈轻至中度正相关;间壁基底、中间和平均Tcec、间壁心尖和前壁Sra与LAAI呈轻至中度正相关.结论 整体结构和心功能正常的高血压病患者已经存在左室局部心肌舒张功能异常并有影响左房构型的趋势.%Objective To evaluate the regional myocardial function in patients with abnormal global structure and function. Methods Essential hypertension patients with normal global LV structure and function ( hypertensive group, n = 54 ) and matched healthy controls ( n = 30 ) were enrolled. Longitudinal peak strain rates ( SR ) during systole, early diastole and late diastole ( SRs, SRe and SRa ) were measured. Tcec ( the interval between electrocardiographic R - wave and the occurrence of compression/expansion crossover ) was calculated by strain rate imaging ( SRI ). The correlations between SRI parameters and conventional echocardiography left atria diameter index ( LADI ) and left atria area index ( LAAI ) were further analyzed. Results SRs of anterior wall ( AW ) basal segments, and, SRe of basal, middle segments and whole wall of interventricular septum wall ( ISW ), basal segments and whole wall of lateral wall( LW ), whole inferior wall ( IW ), basal segments of AW were significantly reduced in hypertensive group. SRa of all segments and whole wall of IWS and AW were significant increased in hypertensive group compared with those in control group. The percentage of SRe/a abnormal segments ( SRe/SRa ＜ 1 ) of every LV wall was significantly higher in hypertensive group than that in control group. There was significant prolonged Tcec of, every segment and whole wall of ISW; basal, middle and whole wall of AW and LW in hypertensive group. Tcec of every ISW segment and LW apical segments, average Tcec of ISW and LW, SRa of LW middle segments were significantly positively correlated with LADI in mild - moderate degree; while Tcec of ISW basal and middle segments, average Tcec of ISW, SRa of AW whole wall and of ISW apical segments were significantly positively correlated with LAAI. Conclusion Abnormal left ventricular regional myocardial movement function occurs before abnormal global structure and function in essential hypertension, which can affect the left atrial configuration.
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