The Ultrasound Evaluation About The Endothelial Function And Change Of Carotid Artery Of The Hypertensive Patients With The Different Types Of Left Ventricular Structure

Essential hypertension (EH) is one of the most common cardiovascular diseases. EH, with a high prevalence rate, easily lead to serious complications which are closely related to vascular injury. Therefore, the study of vascular injury has become the focus of the research of prevention hypertension and its complications. Ultra- sound examination has obvious advantages comparing to X-ray, CT, MRI, digital subtraction angiography technology for the detection of vascular injury. In this paper, high-frequency ultrasound has be- en applied to observe the endothelial function of brachial artery and carotid changes in patients with hypertension, evaluating the relat- ionship between the thicknesses of the inner- middle of carotid and endothelium-dependent diastolic function of brachial artery with differrent left ventricular configuration in patients with hypertens- ion.82 patients with essential hypertension and the control group of 32 cases were involved. Using high-frequency two-dimensional ultrasound and Doppler ultrasound respectively to detect carotid artery diameter, thickness of the inner- middle of carotid artery, the peak of systolic velocity (SPV), the end of diastolic velocity (EDV), resistance index (RI), plus index (PI), percentage of plaque detect- ion, diameter of brachial artery and thickness of the inner- middle of brachial artery endothelium for basis, reactive hyperemia and after nitroglycerin. And calculate the change rate of vascular diam- eter for reactive hyperemia and after sublingual nitroglycerin, while measuring end-diastolic ventricular septal thickness (IVSTd), left ventricular posterior wall thickness (LVPWTd), left ventricular diameter (LVIDd), and calculate left ventricular mass and left ven- tricular mass index (LVM, LVMI). Patients with essential hypert- ension were divided into NLVH group and LVH group According to Ganau classification method, formula LVMI (g/m2) = LVM / BSA (left ventricular mass / body surface area), LVM = 0.8×1.04×[(IVSth + LVDed + LVPWth) 3-LVDed3] +0.6. Normal value of LVMI: LVMI <111g/m2 (male) or LVMI <106g/m2 (female); NLVH group of 42 cases: LVMI in the normal range or less than the nor- mal range; LVH group of 40 cases: more than normal LVMI. SPSS- 11.5 statistical analysis software was used: t-test were used to com- pare the data of groups, single factor linear regression analysis were used to analyze correlation.Results:1. Comparison of general information: age, smoking history, and blood lipid indicators had no significant difference among the three groups, systolic blood pressure and diastolic blood pressure were significant difference among the three groups; the LVMI was significantly increased in LVH group, compared with the NLVH and control groups.2. Comparison of carotid ultrasound parameters: the CCA-IMT of carotid artery was increased in LVH and NLVH gro- ups, compared with the control group; the diameter of carotid artery of LVH group was higher than which of the control and NLVH groups, with a significant difference; CCA-IMT/CCA-D were sig- nificantly different among the three groups, PSV and EDV were lower in the NLVH and LVH groups than them of the control group, with a significantly difference. The detection rate of plaque were increased in turn among three groups, which was the control group the NLVH group>the control group. Blood flow velocity of carotid artery of the hypertensive groups was lower than which of the control group, especially blood flow velocity of the LVH group was significantly low.2. There were positive relationship between the CCA-IMT and LVMI(r=0.492,P<0.05; r=0.537,P<0.05),between the CCA-IMT and the systolic pressure(r=0.353, P<0.05;r=0.422, P<0.05)of the hypertensive patients. As the hypertensive target organs, the heart and arteries had close contact in the pathphysiological mechanism, the carotid atherosclerosis and hypertension is closely related. With the increase of blood pressure, the damage of the arteriosclerosis and the heart structure was increased.3. The endothelium-dependent diastolic function of the hypertensive patients had decreased in different degree, especially in the LVH group. The thickening of CCA-IMT and DTRH% was negatively correlated in the NLVH and LVH groups(r=-0.835,P<0.05;r=-0.875,P<0.01),suggesting that the vascular endothelial dysfunction should be relevant with the early changes of the artery. The endothelial dysfunction maybe was an important link in the generation and development of arterial structural changes.There early were the endothelial dysfunction and a certain change of carotid arteries in the hypertensive patients. These vascular function and structural change were reversible. So the early detection to these changes was of great significant for the prevention of the atherosclerosis. The high-frequency ultrasound machine not only had the two-dimensional ultrasound function, but also had the color Doppler flow imaging with high sensitivity and the spectrum Doppler. The inspection with high-frequency ultrasound was non-invasive and easy to operate, therefore, has been adopted more and more in the clinic use. The ultrasound examination of the carotid artery and the vascular endothelial function can be combined as a better response to the hypertensive vascular damage; it was an objective assessment to further explore the pathogenesis of hypertension and evaluation to pathogenetic condition and treatment.