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目的探讨Tei指数对原发性高血压不同左室构型右室功能的应用价值。方法原发性高血压患者96例,按Ganau分类法将原发性高血压分为4型:正常左室构型(组,25例)、向心性重构(组,26例)、向心性肥厚(组,27例)、离心性肥厚(组,18例);正常对照组30例。以常规超声心动图检查测量舒张末期室间隔和后壁厚度及左室内径(IVS、LVPW、LVEDD),二、三尖瓣血流频谱图舒张早期与舒张晚期血流峰值比(E/A),二尖瓣前叶、三尖瓣隔叶瓣环运动频谱图收缩期运动幅度S峰及舒张早期与舒张晚期峰速比(Ea/Aa),左、右室射血分数(EF)以及Tei指数。结果、、组右室E/A<1,组>1,各组与对照组比较Ea/Aa均<1(P<0.05),组S值减低(P<0.05);组EF值低于正常对照组(P<0.05);高血压、、组Tei指数较对照组增加(0.40±0.16,0.50±0.14,0.68±0.58,0.28±0.03,P<0.05),、组间以及分别与、组间差异有显著性意义(P<0.05);右室Tei指数和右室S值、EF、Ea/Aa及左室EF为轻度负相关(r分别为-0.34,-0.5,-0.35,-0.36;P值均<0.01),与左室Tei指数呈正相关(r为0.55,P<0.01),而和E/A无相关性(P>0.05)。结论右室较左室Tei指数改变发生晚,提示右心整体功能损害晚于左心整体功能的损害。左、右心功能互相依赖,高血压左心功能损害时右心功能也受到了损害。Tei指数能简便、敏感、综合评价高血压病患者右室的收缩和舒张功能,是一项很有发展前途的评价心功能的多普勒超声新指标。
Objective To investigate the value of Tei index in evaluating right ventricular function in patients with essential hypertension with different left ventricular configurations. Methods Ninety-six patients with essential hypertension were divided into 4 types according to Ganau’s classification: normal left ventricular configuration (group, 25 cases), concentric remodeling (group, 26 cases), concentric Hypertrophy (group, 27 cases), eccentric hypertrophy (group, 18 cases); normal control group of 30 cases. The left and right ventricular diameters (IVS, LVPW, LVEDD), the tricuspid blood flow spectrum were measured by conventional echocardiography. The peak values of early diastolic and late diastolic blood flow (E / A) , Anterior mitral valve, tricuspid valve annulus motion spectrum systolic motion amplitude S peak and early diastolic and early diastolic peak velocity ratio (Ea / Aa), left and right ventricular ejection fraction (EF) and Tei index. Results The E / A of right ventricle group was lower than normal (P <0.05), and E / A of group 1 was lower than that of control group (P <0.05) (P <0.05). The Tei index of hypertensive group was higher than that of the control group (0.40 ± 0.16,0.50 ± 0.14,0.68 ± 0.58,0.28 ± 0.03, P <0.05) (P <0.05). The Tei index of right ventricle and S value of right ventricle, EF, Ea / Aa and left ventricular EF were slightly negative correlation (r = -0.34, -0.5, -0.35, -0.36 ; P values were all <0.01), and positively correlated with left ventricular Tei index (r = 0.55, P <0.01), but no correlation with E / A (P> 0.05). Conclusion The change of Tei index in the right ventricle is later than that in the right ventricle, suggesting that the functional impairment of the right heart is later than that of the left ventricle. Left and right heart function interdependent, left ventricular dysfunction in hypertension right heart function has also been compromised. Tei index can be a simple, sensitive and comprehensive evaluation of right ventricular systolic and diastolic function in hypertensive patients, is a promising new indicator of Doppler ultrasound to evaluate cardiac function.