摘要目的:探讨高血压合并舒张功能障碍对主动脉瓣重度关闭不全行主动脉瓣置换术后早期左心室重构的影响。方法:本研究为回顾性病例对照研究，选取2019年3月至2022年1月北部战区总医院心血管外科收治的153例行单纯主动脉瓣置换术的主动脉瓣重度关闭不全患者，男105例，女48例，年龄(57.00±2.11)岁，年龄范围为54～60岁。根据是否患有高血压3级及舒张功能情况分为A组(单纯舒张功能减低， n＝36)、B组(高血压3级合并舒张功能减低， n＝79)与C组(高血压3级合并舒张功能障碍， n＝38)。收集比较三组患者基线资料，术前、术后3个月心脏彩色超声数据，分析高血压合并舒张功能障碍对术后早期左心室重构的影响。 结果:术前，B组室间隔厚度[IVST，(11.58±0.35)mm]、左心室质量指数/左心室舒张末期容积指数[LVMI/LVEDVI，(1.36±0.05)g/ml]高于A组[(10.26±0.30)mm、(1.18±0.05)g/ml]，差异有统计学意义( P<0.05)。术前，C组IVST[(11.75±0.56)mm]、LVMI/LVEDVI[(1.25±0.05)g/ml]与B组比较，差异无统计学意义( P>0.05)。术前，B组左室射血分数[LVEF，(0.56±0.01)]与A组(0.54±0.03)比较，差异无统计学意义( P>0.05)。术前，C组LVEF(0.48±0.02)低于B组，差异有统计学意义( P<0.05)。术后3个月，B组左心室后壁厚度[LVPWT，(11.47±0.26)mm]、IVST[(11.74±0.32)mm]高于A组[(10.48±0.23)mm、(10.61±0.22)mm]，差异有统计学意义( P<0.05)。术后3个月，B组LVMI/LVEDVI[(1.97±0.09)g/ml]与A组[(1.76±0.04)g/ml]比较，差异无统计学意义( P>0.05)。术后3个月，C组LVMI/LVEDVI[(2.09±0.12)g/ml]高于A组，差异有统计学意义( P<0.05)。 结论:术前高血压合并舒张功能障碍可加重主动脉瓣置换术后的早期左心室重构，应在发生舒张功能障碍前采取手术治疗以避免其对左心室重构的不利影响。

abstractsObjective:To investigate the effect of hypertension combined with diastolic dysfunction on early left ventricular remodeling after aortic valve replacement in patients with severe aortic valve insufficiency.Methods:This study was a retrospective case-control study, a total of 153 patients with severe aortic valve insufficiency who underwent isolated aortic valve replacement at department of Cardiovascular Surgery in the General Hospital of Northern Theater Command from March 2019 to January 2022 were selected, including 105 males and 48 females, aged (57.00±2.11) years old, the age ranging from 54 to 60 years old.Based on combining hypertension stage 3 or not and diastolic function status, the patients were divided into A group (isolated diastolic function reduced, n=36), B group (hypertension stage 3 with diastolic function reduced, n=79), and C group (hypertension stage 3 with diastolic dysfunction, n=38).Baseline data and preoperative and postoperative 3-month echocardiographic data were collected and compared to analyze the impact of hypertension stage 3 with diastolic dysfunction for left ventricular remodeling on early period of postoperation. Results:Before operation, interventricular septal thickness[IVST, (11.58±0.35)mm]and left ventricular mass index/left ventricular end-diastolic volume index[LVMI/LVEDVI, (1.36±0.05)g/ml]in B group were higher than those in A group[(10.26±0.30)mm, (1.18±0.05)g/ml], and the differences were statistically significant( P<0.05).Before operation, IVST[(11.75±0.56)mm]and LVMI/LVEDVI[(1.25±0.05)g/ml]in C group compared with those in B group, there were no statistically significant differences( P>0.05).Before operation, left ventricular ejection fraction[LVEF, (0.56±0.01)]in B group compared with that in A group(0.54±0.03), there was no statistically significant difference( P>0.05).Before operation, LVEF in C group(0.48±0.02) was lower than that in B group, and the difference was statistically significant( P<0.05).At three months after operation, left ventricular posterior wall thickness[LVPWT, (11.47±0.26)mm]and IVST[(11.74±0.32)mm]in B group were higher than those in A group[(10.48±0.23)mm, (10.61±0.22)mm], and the differences were statistically significant( P<0.05).At three months after operation, LVMI/LVEDVI[(1.97±0.09)g/ml]in B group compared with that in A group[(1.76±0.04)g/ml], there was no statistically significant difference( P>0.05).At three months after operation, LVMI/LVEDVI[(2.09±0.12) g/ml]in C group was higher than that in A group, and the difference was statistically significant( P<0.05). Conclusions:Preoperative hypertension combined with diastolic dysfunction can aggravate early left ventricular remodeling after aortic valve replacement.Surgical treatment should be taken before diastolic dysfunction occurs to avoid its adverse effects on left ventricular remodeling.