心脏彩超评估高血压左心室肥厚伴左心衰竭患者心功能的临床价值及与NYHA分级的关系研究

目的:探讨心脏彩超评估高血压左心室肥厚(LVH)伴左心衰竭患者心功能的临床价值,分析其超声指标与美国纽约心脏病协会(NYHA)分级的相关性。方法:选择2017年5月至2018年5月我院收治的127例高血压LVH伴左心衰竭患者为观察组,根据NYHA分级将其分为NYHAⅡ级组(41例)、Ⅲ级组(47例)、Ⅳ级组(39例),另选择100例体检的健康志愿者为对照组。所有受试者均接受心脏彩超获得相关参数[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室短轴缩短率(LVFS)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF)、左心室舒张早期充盈峰最大充盈速度/舒张晚期充盈峰最大峰值速度(E/A)比值、Tei指数],分析心脏彩超相关参数与NYHA分级之间相关性。结果:观察组患者LAD、LVEDD、LVESD、LVPWT、IVST、Tei指数高于对照组(P0.05),LVFS、LVEF、E/A比值低于对照组(P0.05)。Tei指数随着NYHA分级增高而增高(P0.05),LVFS、LVEF、E/A比值随着NYHA分级增高而降低(P0.05)。Spearman秩相关分析结果显示,Tei指数与NYHA分级呈正相关(rs=0.398,P0.05),LVFS、LVEF、E/A比值与NYHA分级呈负相关(rs=-0.285,-0.442,-0.305,P0.05)。结论:高血压LVH伴左心衰竭患者发生明显左室肥厚和左心功能降低,心脏彩超可准确评估高血压LVH伴左心衰竭患者的心功能和病情严重程度,且部分心脏彩超相关参数与NYHA分级相关。

Clinical value of Cardiac Color Doppler Ultrasound in Evaluating Cardiac Function in Patients with Left Ventricular Hypertrophy Combined with Left Ventricular Failure and Its Relationship with NYHA Classification

ABSTRACT Objective: To explore the clinical value of cardiac color Doppler ultrasound in evaluating cardiac function in patients with hypertensive left ventricular hypertrophy (LVH) combined with left ventricular failure, and to analyze the correlation between echocardiographic parameters and New York Heart Association (NYHA) classification. Methods: 127 patients with hypertensive LVH combined with left ventricular failure who were admitted to our hospital from May 2017 to May 2018 were selected as observation group. They were divided into NYHA class II group (41 cases), class III group (47 cases) and class IV group (39 cases) according to NYHA classification. Another 100 healthy volunteers were selected as control group. All subjects received cardiac color Doppler ultrasound to obtain relevant parameters[left atrial dimension(LAD), left ventricular end-diastolic dimension(LVEDD), left ventricular endsystolic dimension(LVESD), leftventricular fractional shortening(LVFS), left ventricular posterior wall thickness(LVPWT), interventricular septal thickness(IVST), left ventricular ejection fraction(LVEF), maximum filling velocity ratio of left ventricular early diastolic filling peak to late diastolic filling peak (E/A) ratio, Tei index]. The correlation between cardiac color Doppler ultrasound parameters and NYHA classification was analyzed. Results: The LAD, LVEDD, LVESD, LVPWT, IVST and Tei index of the observation group were higher than those of the control group (P<0.05), and the LVFS, LVEF and E/A ratio were lower than those of the control group (P<0.05). Tei index increased with the increase of NYHA classification (P<0.05), while LVFS, LVEF and E/A ratio decreased with the increase of NYHA classification (P<0.05). Spearman rank correlation analysis showed that Tei index was positively correlated with NYHA classification (rs=0.398, P<0.05). LVFS, LVEF, E/A ratio were negatively correlated with NYHA classification (rs=-0.285, -0.442, -0.305; P<0.05). Conclusion: The patients with hypertension LVH combined with left ventricular failure have significant left ventricular hypertrophy and left ventricular dysfunction. Cardiac color Doppler ultrasound can accurately assess the cardiac function and severity of Hypertension LVH patients with left ventricular failure, and some parameters related to color Doppler echocardiography are related to NYHA classification.