Anatomical M-mode Echocardiography Combined With Strain Rate Imaging Technology To Explore The Metabolic Syndrome In Patients With Left Ventricular Structure And Function Changes

Objective Anatomic M-mode echocardiography combined with strain rate imaging technology to explore the metabolic syndrome patients with left ventricular structure and function changes.Method(1) A total of 102 essential hypertensive in which 44 patient were diagnosed as MS(HMS), 58 patients with hypettension alone(EH)as control. Another 30 normal volunteers accepted various examination. Those cases with diabetes mellitus,secondary hypertension,ischaemic heart disease,cerebrovascular disease or heart failure were excluded in this study. [Hypertension in accordance with the 1999 WHO / ISH guidelines criteria. The MS definition was suggested by a working group consulted by the NCEP in 2002 (hypertensive together with 2 or more the following risk factors:BP≧130/85 mmHg;TG>1.69,and/or HDL-C<1.04 mmol/L(man);central body obesity and/or BMI≧25;microalbuminuria)].(2) routine physical examination and blood chemistry,including height,body weight,waistcircumference,fastingglucose,totalcholesterol,triglycerides,HDL-cholesterol and LDL-cholesterol were performed.Using glucose enzymatic and RIA determination of blood glucose (FSG), plasma insulin (FSI), calculated insulin sensitivity index (ISI).(3) All patients were required to measure E and A flow of mitral valve duringleft ventricular diastole period,then calculated the ratio of E/A. All patients were observed by Anatomic M-mode echocardiography. At left ventricular diastole period end point,Left ventricle inner diameter(LV), At left ventricularsystole period end point, Left ventricle inner diameter, left ventricular posterior wallthickness(LVPW)and interventricular septum thickness(IVS)were measured,then then calculated left ventricular mass(LVM)according to Dereveux formula. Systolic and diastolic strain rate were measured with SRI at two,three and four chamber view.Mean Strain rate (mSR) and SRe/Sra were obtained.ResultsAmong the three groups of age, sex does not exist a statistical significance (P> 0.05). Hypertension with the metabolic syndrome group and the hypertension group, the difference of systolic blood pressure and diastolic blood pressure, is not statistically significant. In addition to TC, , the other clinical data of Hypertension with the metabolic syndrome group compared with the control group, there are significant differences( P <0 .05或P < 0.01).(1) Compared with isolated hypertensive patients,hypertensive patients with MS exhibited more elevated parameters including end-diastolic interventricular septum thickness(IVSD), end-diastolicposterior wall thickness(LVPWd) and left ventricular mass indexed(LVMI)(P<0.01).(2) In comparison with the group of isolated hypertensive patients,hypertensive patients with MS showed significantly higher ratio of LVH(23.9%VS10.6%).(3) Compared with isolated hypertensive patients,hypertensive patients with MS exhibited a reduced ratio of left ventricular normal geometry(NG) (13.7%VS 28.6%,P<0.05),but the ratio of ventricular concentric hypertrophy(CCH) was significantly higher(18.9%VS 7.6%,P<0.05). No significant difference was found in the parameters of ventricular concentric remodeling(CCR)and ventricular eccentrichyper- trophy(ECH) between these two groups(P>0.05).(4) Mean SRs, Mean SRe and SRe/SRa descreased significantly in isolated hypertensive group and hypertensive with MS group than normal group(P<0.05). Compared with hypertensive alone group, Mean SRs,. Mean SRe and SRe/SRa showed statistic difference(P<0.05).(5) Stepwise multiple linear regression analysis showedthat a positive correlation was existed between the parameter of waist circumference and the left ventricular mass index(LVMI) (r=0.351,P<0.01).(6) Hypertensive patients with metabolic syndrome, blood insulin (FSI) was significantly higher than the other two groups (P <0.01), and insulin sensitivity index (ISI) was significantly lower than the other two groups (P <0.01).Summary(1) MS combined with hypertension had more severe left ventricular dysfunction, suggesting that multiple risk factors than a single risk factor had greater impact on cardiac.(2)In addition to blood pressure, the abdominal circumference are a independent predictors of left ventricular hypertrophy. Insulin resistance or high insulin deficiency is an important risk factor for LVH caused byConclusions(1) SRI technology can early find left ventricular dysfunction of metabolic syndrome patients for clinical diagnosis and treatment of MS providing a new more accurate method.(2)Anatomical M-mode echocardiography can more accurately assess the left ventricular remodeling, is worthy of wider use of a new method.