原发性高血压患者心肌微循环损伤的平板运动超声心动图相关数据

Treadmill exercise stress echocardiography of myocardial microcirculatory injury in patients with primary hypertension

摘要:

目的 分析原发性高血压患者心肌微循环损伤的平板运动超声心动图(TESE)相关数据。探讨原发性高血压患者心肌微循环损伤与TESE参数的相关性及其可能的发生机制。方法 选取2018年6月至2019年6月临床确诊原发性高血压患者47例,1周内行TESE检测,同时联合心肌声学造影(MCE)实时评估心肌微循环灌注, 根据心肌微循环显像情况将高血压患者分为微循环正常组和异常组。分析原发性高血压患者心肌微循环损伤与TESE参数的相关性及其可能的发生机制。应用SPSS 23.0统计软件进行数据分析。结果 原发性高血压患者血压严重程度对心肌微血管损伤的影响无明显差异(P>0.05)。高血压心肌微循环损伤患者运动峰值收缩压较正常组患者升高、绝对代谢当量(METs)下降、心脏变时性功能指数减小、运动时间减少、室间隔厚度(IVST)及左心室后壁(LVPWT)较厚,运动峰值左室射血分数(LVEF)减少(P<0.05)。高血压患者心肌微循环损伤与变时性功能、峰值LVEF呈负相关(OR=0.002, 95%CI 0.000～0.981,P=0.049；OR=0.000, 95%CI 0.000～0.028,P=0.002),与LVPWT呈正相关(OR=3.745, 95%CI 1.301～10.774,P=0.014)。结论 TESE可评估高血压心肌微循环损伤患者运动前后心脏结构、功能状态及运动耐量,值得临床推广使用。原发性高血压患者心肌微循环损伤与心脏变时性功能相关,提示自主神经功能紊乱可能是原发性高血压患者心肌微循环损伤的发病机制之一。

Abstract:

Objective To analyze the data obtained from treadmill echocardiography (TESE) of myocardial microcirculatory injury in patients with primary hypertension and to investigate the relationship between myocardial microcirculatory injury and TESE parameters in those patients and its possible mechanism. Methods A total of 47 patients with clinically diagnosed primary hypertension were enrolled from June 2018 to June 2019. All patients underwent TESE within one week. At the same time, myocardial microcirculation perfusion was evaluated in combination with myocardial contrast echocardiography (MCE). According to imaging of myocardial microcirculation, hypertensive patients were divided into normal group and abnormal group. An analysis was done of the correlation between myocardial microcirculatory injury and TESE parameters in patients with primary hypertension and its possible mechanism. SPSS statistics 23.0 was used for data analysis. Results In patients with primary hypertension, there was no significant difference in the association between the severity of hypertension and myocardial microvascular injury (P>0.05). In the abnormal group, higher peak systolic blood pressure, lower metabolic equivalents (METs), lower cardiac dysfunction index, shorter exercise time, thicker interventricular septum thickness (IVST) and left ventricular posterior wall (LVPWT), and lower peak left ventricular ejection fraction (LVEF) than in the normal group (P<0.05). Multivariate analysis showed that, in patients with hypertension, myocardial microcirculatory injury was negatively correlated with chronotropic function and peak LVEF (OR=0.002,95%CI 0.000-0.981, P=0.049; OR=0.000, 95%CI 0.000-0.028, P=0.002) and positively correlated with LVPWT (OR=3.745,95%CI 1.301-10.774, P=0.014). Conclusion TESE can evaluate cardiac structure and functional status before and after exercise, and exercise tolerance in patients with hypertensive myocardial microcirculatory injury, which is worthy of clinical application. Myocardial microcirculatory injury inpatients with primary hypertension is associated with cardiac chronotropic function, suggesting that autonomic dysfunction may be involved in the pathogenesis of myocardial microcirculatory injury in patients with primary hypertension.