摘要目的 探讨纵向峰值应变(longitudinal peak strain , LPS )及应变达峰时间离散度(peak strain dispersion , PSD)评价左室射血分数(left ventricular ejection fraction , LVEF)≥50% 的原发性高血压患者左室收缩功能及同步性的临床应用价值.方法 选取LVEF≥50% 的原发性高血压患者55例,根据左室肥厚标准分为两组:非左室肥厚(non‐left ventricular hypertrophy , NLV H )组30例,左室肥厚(left ventricular hypertrophy , LV H )组25例,同期选取30例健康志愿者作为对照组.三组均行经胸二维超声心动图检查,采集连续3个心动周期的左室心尖四腔、三腔、两腔长轴切面二维动态图像.应用分层应变技术测定左室心内膜下、中层、心外膜下、全层心肌收缩期LPS及 PSD并进行三组间应变值比较、相关性分析及ROC曲线分析.结果 对照组、 NLVH组及LVH组各层LPS的绝对值逐渐减低.与对照组比较,NLVH组心内膜下、中层及全层心肌LPS绝对值均减低,差异有统计学意义( P ＜0 .05) ;心外膜下心肌LPS绝对值略低于对照组,差异无统计学意义( P ＞0 .05) ; LVH组心内膜下、中层、心外膜下及全层心肌LPS绝对值均减低( P ＜0 .05) ;与NLVH组比较,LVH组心内膜下及中层心肌LPS绝对值明显减低( P ＜0 .05) ;两组心外膜下及全层心肌LPS绝对值差异无统计学意义( P ＞0 .05) ;与对照组比较, NLV H组和LV H组 PSD均增加( P ＜0 .05) ;与 NLVH组比较, LV H组PSD增加( P ＜0 .05) .室间隔厚度(inter‐ventricular septum thickness , IVSd)与心内膜下、中层、心外膜下、全层心肌LPS均呈负相关( r ＝ －0 .537 ,－0 .518 ,－0 .266 ,－0 .471 ;均 P ＜0 .05) ,左心室后壁厚度(left ventricle posterior wall thickness , LVPWd)与心内膜下、中层、心外膜下、全层心肌LPS均呈负相关( r ＝ －0 .539 ,－0 .524 ,－0 .283 ,－0 .478 ;均 P ＜0 .05) .心内膜下、中层、心外膜下、全层心肌LPS及PSD诊断不同左室构型高血压的ROC曲线下面积(AUC )分别为0 .685 、 0 .652 、 0 .510 、 0 .623 、 0 .995 ,最佳分界值分别为 －21 .70%、－18 .90%、－16 .95%、－19 .45%、 46 .50 ms ,相对应的敏感性分别为94 .4%、 83 .3%、 77 .8%、 94 .4%、 100%,特异性分别为47 .8%、 52 .2%、 39 .1%、 39 .1%、 95 .7%.结论 分层应变技术可定量评价原发性高血压患者心肌纵向应变,为诊断高血压心脏病变、评估左室心肌分层受累程度提供了一种无创检查方法. PSD评价原发性高血压患者左室心肌收缩同步性改变具有一定的优势.

abstractsObjective To investigate the clinical application value of longitudinal peak strain( LPS ) and peak strain dispersion ( PSD ) in evaluating left ventricular systolic function and synchrony in patients with essential hypertension . Methods Fifty‐five patients with essential hypertension were enrolled , including 30 patients with non‐left ventricular hypertrophy ( NLV H ) , 25 patients with left ventricular hypertrophy ( LV H ) , at the same time , 30 healthy volunteers were selected as the control group . Echocardiography was performed in all three groups ,and two‐dimensional dynamic images of the left ventricular apical four‐chamber ,three‐chamber ,and two‐chamber′s long‐axis view s were collected for three consecutive cardiac cycles . T he myocardial layer‐specific strain was used to measure the LPS of the left ventricular myocardium of subendocardium ,the middle layer ,the subepicardium ,and the myocardial strain and the PSD of the w hole myocardial layers . Correlation analysis and ROC curve analysis were performed . Results T he LPS in the control group ,NLV H group and LV H group were decreased in turn from inner to out myocardial layers . Compared with the control group , the LPS in the subendocardial , middle , subepicardial ,and w hole myocardial layer of NLV H group were decreased ( P ＜ 0 .05 ) , and the subepicardial myocardial LPS was slightly lower than that in the control group ,the difference was not statistically significant ( P ＞ 0 .05 ) . T he LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer of LV H group were all reduced ( P＜0 .05) . Between the NLV H group and LV H group , the declines of the LPS in the subendocardial and middle layer in the LV H group were statistically significant ( P ＜0 .05) ,the LPS in the subepicardial layer and the w hole myocardial layer had no significant difference ( P ＞0 .05) . Compared with the control group ,the PSD of the NLVH group and the LVH group increased ( P ＜ 0 .05 ) . Compared with the NLV H group ,the PSD of the LV H group increased ( P ＜0 .05) . Inter‐ventricular septum thickness ( IVSd) and the LPS in the subendocardial ,middle ,subepicardial , and w hole myocardial layer were negatively correlated ( r ＝ －0 .537 ,－0 .518 ,－0 .266 ,－0 .471 ; all P ＜0 .05) , left ventricle posterior wall thickness ( LVPWd ) and the LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer were negatively correlated ( r ＝ －0 .539 , －0 .524 , －0 .283 ,－0 .478 ;all P ＜0 .05) . T he area under the ROC curve ( AUC) of the LPS in the subendocardial ,middle , subepicardial ,and w hole myocardial layer and PSD for the diagnosis of hypertension were 0 .685 ,0 .652 , 0 .510 ,0 .623 ,0 .995 ,respectively . T he cut‐off values were －21 .70% ,－18 .90% ,－16 .95% ,－19 .45% , 46 .50 ms , and the sensitivities were 94 .4% , 83 .3% , 77 .8% , 94 .4% , 100% , respectively , and the specificities were 47 .8% ,52 .2% ,39 .1% ,39 .1% ,95 .7% ,respectively . Conclusions T he layer‐specific strain can quantitatively evaluate myocardial longitudinal strain in patients with essential hypertension , provide a non‐invasive test for early diagnosis of hypertensive heart disease ,and the evaluation of left ventricular myocardial stratification . PSD for evaluating primary synchronous changes in left ventricular myocardial contraction in patients with hypertension has certain advantages .