LVGLS对高血压患者不同左室构型的收缩功能评价

The LVGLS Evaluation of the Systolic Function in Patients with Essential Hypertension and Different Left Ventricular Geometries

摘要: 目的：通过二维心脏超声斑点追踪技术(2D-STI)评估原发性高血压患者的左室整体纵向应变(LVGLS)，旨在探讨不同左室构型的原发性高血压患者收缩功能的变化特征。方法：本研究选取了2023年5月至2024年12月在昆明医科大学第二附属医院心血管内科住院且左室射血分数(LVEF)正常的148名原发性高血压患者作为研究对象，同时选取与之年龄、性别相匹配但无心脑血管疾病的19名健康成年人作为对照组。依据左室质量指数(LVMI)和相对室壁厚度(RWT)，将高血压患者分为四个亚组：正常几何构型组(NG)、向心性重构组(CR)、向心性肥厚组(CH)及离心性肥厚组(EH)。所有参与者均接受了超声心动图检查，并记录了包括左心房内径(LAD)、左室间隔舒张末期厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、LVGLS、左室内径(LVDd)以及LVEF在内的多项参数。进一步分析LVGLS在各组别间的差异。结果：与其余四组相比，CH组的IVST、LVPWT、LVMI最大；EH组的LVDd高于其余四组；CR组在LVDd、LVPWT、IVST及RWT大于NG组和对照组；高血压左室构型亚组的LVGLS值均低于对照组，其中EH组的LVGLS低于NG组及对照组；以上各项差异均有统计学意义(均P < 0.05)。结论：LVGLS能够有效地反映在LVEF处于正常范围内的原发性高血压患者中，不同左室结构变化对其收缩性能的影响。

Abstract: Objective: To evaluate the left ventricular global longitudinal strain (LVGLS) in patients with primary hypertension using two-dimensional echocardiography speckle tracking imaging (2D-STI), aiming to explore the characteristics of changes in systolic function among patients with different left ventricular geometries. Methods: This study selected 148 patients with primary hypertension who were hospitalized in the Department of Cardiology at the Second Affiliated Hospital of Kunming Medical University between May 2023 and December 2024 and had normal left ventricular ejection fraction (LVEF). Additionally, 19 healthy adults matched for age and gender without cardiovascular or cerebrovascular diseases were selected as the control group. Based on the left ventricular mass index (LVMI) and relative wall thickness (RWT), the hypertensive patients were divided into four subgroups: normal geometry group (NG), concentric remodeling group (CR), concentric hypertrophy group (CH), and eccentric hypertrophy group (EH). All participants underwent echocardiography, and multiple parameters including left atrial diameter (LAD), left ventricular septal end-diastolic thickness (IVST), left ventricular posterior wall end-diastolic thickness (LVPWT), LVGLS, left ventricular end-diastolic diameter (LVDd), and LVEF were recorded. Further analysis was conducted to assess the differences in LVGLS among the groups. Results: Compared with the other four groups, the CH group had the highest IVST, LVPWT, and LVMI; the EH group had higher LVDd than the other four groups; the CR group had greater LVDd, LVPWT, IVST, and RWT than the NG group and the control group; the LVGLS values of the hypertensive left ventricular geometry subgroups were all lower than those of the control group, with the EH group having lower LVGLS than the NG group and the control group; all these differences were statistically significant (all P < 0.05). Conclusion: LVGLS can effectively reflect the impact of different left ventricular structural changes on systolic performance, even in patients with primary hypertension who have a normal LVEF range.