Preliminary Study On The Relationship Between Intracardiac Blood Flow And Left Ventricle Configuration And Its Diastolic Function In Patients With Essential Hypertension

BackgroundEssential hypertension is a common clinical disease with increased systemic arterial pressure as the main feature,which can cause heart,kidney and other target organs function damage.Studies have shown that hypertensive heart disease is one of the most important factors of ejection fraction preserved heart failure,thus the accurate evaluation of left ventricular function is vital for early diagnosis.As a result of the ventricular post-load increase,intracardiac hemodynamic change take place as normal vortex disappear,followed by diastolic dysfunction and ventricular remodeling.The relationship between hemodynamic change and diastolic function and remodeling needs further study.With the help of vector flow imaging(VFM)technique,the quantitative changes of intracardiac hemodynamics can be evaluated to calculate the energy loss and vortex circulation in the process of cardiac flow.Previous studies have used Ganau configuration classification with the European and American population criterion,and the hemodynamic feature that conform to the characteristics of the Chinese population are not yet reported and need further study.Objective1.To compare the distribution characteristics of hypertension with Chinese standard and international standard.2.To quantitively evaluate the energy loss and vortex circulation in diastolic left ventricle in patients with essential hypertension under the criteria of Chinese population.3.To explore the relationship between blood flow changes and diastolic function,and to explore the value of VFM in evaluating left ventricular diastolic function in patients with essential hypertension.SubjectHypertension group:63 patients diagnosed as essential hypertension at Qilu Hospital of Shandong University without other diseases.Control group:23 healthy volunteers with matched age and gender.Method1.The basic informationIncluding the name,age,gender,height,weight,heart rate,blood pressure,history and other basic information.2.Two-dimensional ultrasound imageUsing the Japanese Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic apparatus,collect the images of parasternal long axis,apical four-chamber,apical two-chamber in at least three cycles to measure and calculate as follows:LVID,IVS,LPW,LVM,LVMI,RWT,AO,LAD,LAV,LAVI,E,A,E/A,DT,TRY,e'(s),e'(l),E/e' and LVEF.3.VFM measurementSwitch to the VFM mode to collect the apical three-chamber images in three cycles,keep the frame rate higher than 20 frames/s,analyze the data in offline DAS-RS13.0 workstation.Measure the average energy loss and vortex circulation and area in left ventricle at different phases.4.Using SPSS23.0 for statistical analysisResult1.The basic data comparison(1)The subgroup under the European and American Ganau criterion have significant difference with the subgroup under Chinese criterion(p<0.05).(2)Hypertension group compared with the control group has no significant difference in heart rate(p>0.05).In hypertension group,SBP and DBP is higher than the control group(p<0.05).There is no significant difference between the subgroups(p>0.05).2.Two-dimensional ultrasound comparison(1)Left ventricular wall thickness:IVS,LVPW,RWT of the hypertension group is significantly higher than those of the control group(p<0.05).(2)The diameter of chamber:LAD and AO of the hypertensive group is significantly higher than that of the control group(p<0.05).There is no significant difference of LVID between two groups(p>0.05).(3)Left ventricular mass:LVM and LVMI of hypertension group is significantly higher than those of control group(p<0.05).(4)Left atrial volume:LAV and LAVI in the hypertension group is significantly higher than that in the control group(p<0.05),and the LAV of the EH group and the CH group is significantly larger than the NG group(p<0.05).(5)LVEF:There was no significant difference between the two groups(p>0.05).(6)Mitral orifice velocity:The E/A of the hypertension group is lower than that of the control group but A is higher(p<0.05).There was no significant difference in E,DT between the hypertension and control group(p>0.05).(7)Mitral annulus myocardial velocity:e'(s)and e'(1)in hypertension group is lower than that in the control group and so does each subgroups of hypertension(p<0.05).The E/e' of the hypertension group and its subgroups is higher than that in the control group(p<0.05)(8)Tricuspid regurgitation velocity:There was no significant difference between the hypertension and control group(p>0.05).3.Chinese criteria energy loss comparison(1)Isovolumic relaxation,rapid filling and slow filling period:There is no significant difference in the average energy loss of the left ventricular,basal,middle and apical segments of the hypertensive group compared with the control group(p>0.05).(2)Atrial contraction period:Compared with the control group,the average EL of the left ventricular,basal and middle segments of the hypertension group is higher(p<0.05),and the apical segment has no difference(p>0.05).Compared with control group,the average EL of the basal and middle segment in EH group is higher(p<0.05),and that of the middle segment of the NG group is higher(p<0.05).The average EL in the middle segment of CH group is lower than that in NG group and EH group,the difference was statistically significant(p<0.05).4.Chinese criteria vortex comparison(1)Isovolumic relaxation:no vortex occurred in hypertension group and control group;(2)Rapid filling period:there is no significant difference in vortex circulation,vortex area between the two groups(p>0.05).(3)Slow filling period:there is no significant difference in vortex circulation,vortex area and vortex duration between the two groups(p>0.05).(4)Atrial contraction period:compared with the control group,the vortex circulation and area under posterior valve is significantly higher(p<0.05).5.Configuration analysisThe subgroup analysis under the European and American Ganau criterion find no significant difference in energy loss between subgroups(p>0.05).6.Correlation analysis(1)For hypertension subjects,there is a significant correlation between the average EL of the basal segment in the atrial contraction period with e'(s)?e'(l)?E/e'(p<0.05).(2)For hypertension subjects,there is a significant correlation between the vortex circulation and area of posterior valve in the atrial contraction period with e'(s)?e'(l)?E/e'(p<0.05).Conclusion1.By the means of Ganau configuration,the compose of subgroup differs under the criterion of European-American and Chinese population.2.The Chinese population criterion of ultrasound can acquire a better reflection of the left ventricular energy loss in hypertension patients.3.Compared with the normal control,the average EL,vortex circulation and area increased in the hypertension group,which has a correlation with diastolic function.