Study On Geometry Morphology And Function Of Left Ventricle In Patients With Chronic Pulmonary Artery Hypertension

Objective:1To study whether left ventricular (LV) reconstruction was happed andthe correlation with the degree of PH applying ultrasonic cardiogramtechnology in patients with pulmonary hypertension (PH), and screen the maininfluence factors causing LV structure change.2To research the influence of LV diastolic and systolic function,especially the influence of the LV diastolic function in patients with differentdegree of PH applying ultrasonic cardiogram technology，and research thecorrelation LV reconstruction and LV diastolic function.Methods:1Forty six chronic PH patients were selected in this study from December of2011to December of2012, and divided into three groups(mild, moderate, andsevere) by pulmonary arterial systolic pressure(PASP):①group LPH(30mmHg≤PASP＜50mmHg， total15， male8, female7; average age56.7±15.3years);②g roup MPH(50mmHg≤PASP＜70mmHg，total14,male7,female7; average age48.3±11.9years);③g roup SPH(PASP≥70mmHg，total17,male6, female11; average age44.0±13.1years). All the patients wereunderwent inquiry history, physical examination, ECG, UCG and other testsexcluding patients with acute pulmonary hypertension, diabetes, valvulardisease, congenital heart disease, cardiomyopathy and impaired LV functioncaused by hypertension, coronary heart disease and other diseases. Healthyvolunteers （total15, male6, female9; average age48.9±11.5years） wereselected as the control group.2Use instrument: the Siemens ACUSON SC2000ultrasonic diagnosticinstrument with4V1cardiac transducer was used in this study, and LVfunction was analysed automatically with built-in software. 3All participants take the left decubitus, quiet breathing, and link synchronousECG and record conventionally gender, age, heart rate (HR), height (H),weight (W), etc.3.1Two-dimensional echocardiography: To measure the left ventricular front-back wall lines (D1), interval-side lines (D2) in left ventricular short axissection papillary muscles level with two-dimensional echocardiography, andcalculate LV end-systolic eccentric index (EIs) and end-diastolic eccentricindex (EId).3.2Spectrum and color doppler echocardiography①To measure tricuspid regurgitation speed and differential pressureacross the valve in the apex-four-chamber section, and assess PASPcombined with the inferior vena cava inner diameter and collapse rate withspectrum doppler echocardiography.②To get mitral valve blood flow spectrum in the apex-four-chambersection and measure the highest velocity of E peak and A peak. To estimationpulmonary vascular resistance (PVRe)((PVRe=TRV x10/TVIRVOT+0.16)(TRV: tricuspid regurgitation speed, TVIRVOT: right ventricularoutflow tract speed-time integral)with echocardiography is very effective Inthe diagnosis of PVR increase (>1.8Wood Units),but underestimate thehighest PVR. Correction formula (PVRc=3.2×PVRe－4.5) of the PVRe isused in PVR>2.0wood units.3.3Tissue doppler echocardiography: Placing the sampling volume in mitralvalve ring left ventricular free wall side to get tissue doppler spectrum in theapex-four-chamber section entering the TDI mode with tissue dopplerechocardiography. These spectrums include systolic spectrum S’, earlydiastolic spectrum E’, late diastolic spectrum A’. To measure S’ duration (b),the duration(a) from A’ over time to the next cardiac cycle E’ start time andcalculate LV diastolic function index, E’/A’, E/E’. We should measure duration(IVCT) from the end of A’ to the start of S’ of the next cardiac cycle andduration (IVRT) from the end of S’ to the start of E’.3.4Vp measurement: To measue Vp, and calculate E/Vp with M type ultrasonic doppler placing color doppler sampling frame in the left chamberand placing sampling line in between mitral valve tip and apex inapex-four-chamber section. To calculate left ventricular ejection fraction(LVEF) through the apex four cavity and two cavity double plane Simpson.Results:1The comparison of LV structure parametersWith the increase of PASP, LVEIs increased gradually, the difference in eachgroup were statistically significant (P <0.05).With the increase of PASP,LVEId increased gradually, the difference in each group were statisticallysignificant (P<0.05).With the increase of PASP, the degree of LVEIsincreasing is more than that of LVEId.2The comparison of LV function parameters2.1The comparison of LVEF: With the increase of PASP, LVEF decreasedgradually. Although there were differences in the SPH group and controlgroup, group LPH, group MPH(P＜0.05), the LVEF of the SPH group isstill in the normal range.2.2The comparison of LV Tei: With the increase of PASP, LV Tei increasedgradually. There were differences the rest of the each group (P <0.05) exceptthat there was no statistical significance (P>0.05) between the control groupand group LPH.2.3The comparison of E’/A’: With the increase of PASP, E’/A’ decreasedgradually and the difference in each group were statistically significant (P <0.05).The comparison of the E/E ’: With the increase of PASP, E/E’ increasedgradually. In the comparison of the E/E’, there were statistical significances inthe differences between control group and group SPH, and that between groupMPH and group SPH. There were no statistical significances in the differencesof the rest of the each group (P <0.05).The comparison of the E/Vp: With the increase of PASP, E/Vp increasedgradually. The differences between control group and groups PH werestatistically significant (P <0.05). The differences among groups PH were no statistically significant (P>0.05).3Correlation analysisPASP is positively correlated with LVEIs, LVEId. PASP is positivelycorrelated with E/E ’, E/Vp, Tei index. PASP is negatively correlated with E’/A’. PASP has significant correlation with Tei index, E’/A’. E’ and E’/A’ isnegatively correlated with LVEIs and LVEId. E/E’，Tei index，IVRT ispositively correlated with LVEIs, LVEId.4Screening main factors influencing LV remodeling in patients with PH: Themain influential factor of LVEIs includes PASP, SV and LVEF. The maininfluential factor of LVEId includes PASP.Conclusions:1LV reconstruction was happened in patients with PH. The higher ofPASP increased, the more obviously of the degree of LV reconstruction. Themain influencing factor of Left ventricular remodeling was PASP。2Changes in LV function in patients with PH were mainly reduceddiastolic dysfunction, systolic function only in patients with SPH slightlyreduced, but still within the normal range.3Echocardiography technology could early, sensitively evaluate LVgeometry morphology and function in patients with PH.