The Study On Left Ventricular Diastolic Function In Patients With H Types Of Hypertension Using Technologies Of Echocardiography

Objective:To evaluate left ventricular diastolic function in patients with H types of hypertension by technologies of echocardiography and to carry on the preliminary discussion of its possible clinical significance.Methods:One hundred and fifty-nine patients with essential hypertension were enrolled in the research. During April 2014 and February 2015. According to the plasma homocysteine(HCY) levels, the patients are divided into group A(hypertension with HCY<10μmmol/L) and the group B(hypertension with HCY≥10μmol/L). Twentyfour healthy volunteers served as normal control subjects(group N). The Philips i E33 system was used, which was equipped with X5-1 transducer(1.0-5.0MHz). The parameters of ultrasonic cardiogram examination included routine 2D ultrasound measurement of left ventricular diastolic dimension(LVDd), left ventricular systolic dimension(LVDs), interventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), left arterial dimension(LAD). The left ventricular ejection fraction(LVEF) was calculated according to the Simpson rule. The peak velocity of early rapid filling wave(E-wave velocity) and peak velocity of the late filling wave due to atrial contraction(A-wave velocity), E deceleration time(DT), E/A velocity ratio were measured using conventional mitral flow doppler and the pulmonary venous flow velocity(S wave, D wave, A wave and S/D) were obtained, The mitral annular velocity: early diastolic tissue velocity(Em), late diastolic tissue velocity(Am), isovolumic relaxation time(IRT), Em/Am and E/Em were obtained using pulsed-wave tissue Doppler imaging(PW-TDI). Tei index was calculated according to the formula Tei=a-b/a. The left ventricular flow propagation velocity(Vp) were measured using color M-mode doppler(CMD), The left atrial volume were measured by real-time three-dimensional echocardiography(RT-3DE), then left atrial volume index(LAVI) was calculated. All patients were recorded general conditions including height, weight, body surface area(BSA), history of smoking and drinking. The blood pressure, glucose, lipid and plasma HCY were measured.Results:1. HCY was significantly higher in group B than that of group N and group A (P<0.05). The systolic blood pressure and triglyceride were significantly higher in group A and group B than that of group N(P<0.05), TC was higher in group A than that of group N and group B(P<0.05). The rest clinical information and biochemical indexes were no statistically significant difference among three group(P>0.05).2. The LVDd, LADs, LAD, IVST, LVPWT and LVEF were no significant difference among the three groups(P>0.05).3. Compared with normal control group, E/A and Em/Am were lower and E/Em was higher in group A and group B.(P<0.05); Compared with group A, Em/Am was lower and E/Em was higher in group B(P<0.05), but there was no significant difference of the E/A between group A and group B(P>0.05). The DT and IRT gradually increased in group N, group A and group B, but only IRT had a statistical significance between group N and group B(P<0.05), the DT was no signifcant difference among three group(P>0.05). The S/D gradually decresed in group N,group A and group B, but only had difference between group N and group B(P<0.05).4. Compared with group N, the LAVI and Tei index were higher and the Vp was lower in group A and group B(P<0.05). The LAVI and Tei were significant higher in group B than that of group A,(P<0.05), The Vp was significant lower in group B and group A than that of group N,and the Vp was significant lower than that of group A(P<0.05).5. In the patients with hypertension there was a positively correlated between Tei index and E/Em(P<0.05), and there was a negatively correlation between Tei index and Em/Am, there was no correlation between Tei index and E/A(P>0.05).6. In the patients with hypertension there was a negatively correlation between Vp and E/Em(P<0.05) and there was a positively correlation between Vp and Em/Am(P<0.05). There was no correlation between Vp and E/A(P>0.05).7. There was a positively correlation between LAVI and E/Em(P<0.05), and there was a negatively correlation between LAVI and Em/Am or E/A(P<0.05) in the patients with hypertension8. There was a negatively correlation between Tei index and Vp(r=-0.432, P<0.01).There was a positively correlation between Tei index and LAVI(r=0.336, P<0.05);.There was a negatively correlation between Vp and LAVI(r=-0.300, P<0.05).9. In the patients with hypertension there was a positively correlation between HCY and systolic blood pressure, LAVI, Tei index or E/Em(P<0.05) and there was a negatively correlation between HCY and Vp, Em/Am(P<0.05). In which thecorrelation coefficient of HCY with the E/Em, LAVI, Vp, or Tei index was higher,respectively 0.839, 0.666, 0.519 and-0.548. There was no correlation between HCY and age, course of hypertension, DBP, LVEF or E/A(p>0.05).Conclusion:1. Left ventricular diastolic function had changed before geometric or ventricular systolic function abnormality in hypertensive patients.2. The diastolic function was impaired more obviously in patients with H type hypertension than that in hypertensive patients without HHCY and HCY had significant correlation with many diastolic function parameters, suggesting that HHCY my be some relationship with left ventricular diastolic dysfunction.3. Left atrial volume index cloud sensitively reflect left atrial size compared with left atrial diameter and it may be a better index to reflect left arial structure..4. Tei index, Vp and LAVI had good correlation with the traditional ultrasound indexes and had no pseudo normal in evaluating left ventricular diastolic function,and they my be more widely used to evaluate of left ventricular diastolic function.5. Whether the treatment of H type hypertension can be delay the progression of left ventricular diastolic dysfunction is still needed further study.