Study Of Ventricular Function And Relationship In Patients With Essential Hypertension By Echocardiography

BackgrondHypertension as a usual illness is the main cause of death of cardiovascular diseases. Hypertension can result in changes of cardiac structure and function. To diagnose these abnormal changes early and correctly is essential in clinics.Echocardiography is becoming popular in evaluation of cardiac function for its noninvasive nature, convenience ,easy repetition and high accuracy. Not only some ultrasonic technologies as M mode, 2D echocardiography, Doppler echocardiography, .acoustic quantification and TDI, but also three-dimensional echocardiography was used in this research to assess left ventricular mass and the cardiac functions quantitatively in patients with hypertension. Objectives1.Using 2DE, Doppler echocardiography, acoustic quantification and tissue doppler imaging to assess the changes of diastolic and systolic ventricular function in patients with hypertension. 2.Using real-time three-dimensional echocardiography to assess left ventricular mass and the changes of systolic and diastolic ventricular function in patients with hypertension.3.to disscuss the relationship between the left and right ventricularfunction.MethodsThere are 38 cases of normal person in normal control group, mean age(48.9± 11.2), who have no history of hypertension ,coronary heart disease or family history and appear normal in history acquisition,physical examination ,biochemical examination of blood, hepatic and renal examination ,ECG, chest fluoroscopy and cardiac echocardiography.The patients in hypertension group accord with following standards.WHO-ISH hypertension diagnosis standard in 1999 with BP less than 180/110mmHg;age<75 years old;without history of coronary heart disease or family history;with cardiac function in I—II grade according to NYHA standard;consents of patients.According to Devereux formula ,LVMI(>135g/m2 in male,>l 11 g/m2 in female)is the standard of left ventricular hypertrophy.The hypertension group is divided into LVH(Left Ventricular Hypertrophy) which has 31 cases, mean age (50.17+11.1) and NLVH(Normal Left Ventricular Hypertrophy) group.which has 36cases,mean age (49.3+10.8.).Echocardiograms were obtained by SONOS-7500 color Doppler echocardiography of Pillips Company in Holland,using M mode,2D, Doppler echocardiography, AQ, TDI and three-dimensional echocardiography.All images and data were recorded on VHS video and magnetic optical disc for analysis.Use SPSS10.0 statistical analysis software was used to analysis the data.Nonpairing t-test was used to compare the patient group and control group5and analysis of variance was used in multi-group comparison with p<0.05 as significant discrepancy,and p<0.01 as extraordinary significant discrepancy.Result1.There was no significant difference in age height weight andvariation of heart rate.2.Data obtained by M-mode and 2D echocardiography:Compared to control group,LVEF of LVH group decreased,while thatof NLVH group didn't change.3.Data obtained by Doppler echocardiography:Left ventricle:Compared to control group, E, E/A of hypertensiongroup is smaller than that of control group. IRT\ EDT becomeslonger, A peak is higher than E peak .Right ventricle: Compared to control group, En E/A of hypertension group is smaller than that of control group. IRT\ EDT becomes longer, A peak is higher than E peak . 4.Data obtained by AQ technique:Compared to control group, hypertension group has larger AF ,PAFR and smaller RF/AF,PRER,TF and RF of LVH group is smaller than those of NLVH group.Compared to control group,the left atrium of hypertension group has larger LAPAER.The EF of the left atrium in LVH group has significant change.Compared to control group,canal volume of LVH group decreased,the left atrial reservoir volume and end systolic volume of left atrium in NLVH and LVH group increased significantly. 5. Data obtained by TDI:Left ventricle:Compared to control group, Em, Em/Am decreased in patients with hypertension,while Am increased. Compared to NLVH group, Em> Em/Am decreased in patients with LVH. Right ventricle: Compared to control group, Em, Em/Am decreased in patients with hypertension. Compared to NLVH group, Em/Amdecreased in patients with LVH.6. Data obtained by three-dimensional echocardiography There was no significant differences between the measurements of real-time 3-DE 16-plane and 8-plane. There was no significant differences between the measurements of real-time 3-DE 2-plane and 2DE. But there were significant differences between the measurements of real-time 3-DE 16-plane 8-plane and those of 4-plane^ 2-plane, 2DE. There were significant differences between the measurements of real-time 3-DE 4-plane and those of 2-planeN 2DE. Compared to control group, hypertension group has larger LVM and LVMI. Compared to control group, hypertension group has larger EDV and ESV. EF of left ventricle decreased in LVH group while that of right ventricle had no changes. Compared to control group, hypertension group has larger LAVmax and LAVmin. LAVmin/LAVmax increased in LVH group while that had no change in NLVH group.7.Relationship between the left and right ventricular diastolic function: E/Em, Em/Am of left ventricle were correlated well with those of right ventricle. Conclusion1, Cardiac function can be evaluated accurately by echocardiography.2, Changes may occur in systolic and diastolic function in Hypertension patients,and diastolic changes occur first. Systolic and diastolic function of left ventricle were well correlated with those of right ventricle.3, Three-dimensional echocardiography can assess the left and right ventricular function and quantify left ventricular mass accurately.