利用CCTA分析舒张期扩张指数与升主动脉弹性及心肌缺血的关系-东南大学学报医学版

利用CCTA分析舒张期扩张指数与升主动脉弹性及心肌缺血的关系

单位：河北北方学院附属第一医院医学影像部, 河北张家口 075000

分类号：R541; R816.2

出版年·卷·期（页码）：2023·42·第二期（289-294）

摘要：

目的:利用冠状动脉CT造影检查(CCTA)分析原发性高血压患者舒张期扩张指数(DE)与升主动脉弹性及心肌缺血的关系,评估原发性高血压患者升主动脉病变及功能性心肌缺血。方法:收集经临床确诊原发性高血压并行CCTA检查的84例患者纳入研究,根据冠状动脉无创血流储备分数值分为心肌缺血组(39例)和无心肌缺血组(45例)。根据DE判断是否存在左心室舒张功能异常,分为左室舒张功能异常组和左室舒张功能正常组。基于CCTA数据测量并计算冠状动脉血流储备分数、DE及升主动脉压力-应变弹性系数(Ep)。分析DE与Ep的相关性以及DE与心肌缺血的关系。结果:心肌缺血组和无心肌缺血组的DE与Ep均呈负相关(r＝-0.736、-0.431,P＜0.05);DE是升主动脉Ep的独立影响因子(β＝-0.420,t＝-5.002,P＜0.05);左室舒张功能异常组发生功能性心肌缺血的风险是左室舒张功能正常组的3.188倍。结论:原发性高血压患者的DE与升主动脉弹性及心肌缺血关系密切。DE能为临床早期预测原发性高血压患者升主动脉弹性下降及功能性心肌缺血的发生提供有效参考。

Objective: To analyze the relationship between diastolic expansion index(DE),ascending aortic elasticity and myocardial ischemia in patients with essential hypertension by coronary artery computed tomography angiography(CCTA), so as to early evaluate the ascending aortic disease and functional myocardial ischemia in patients with essential hypertension. Methods: 84 patients with clinically diagnosed essential hypertension who underwent CCTA were enrolled.According to the value of coronary noninvasive blood flow reserve,the patients were divided into myocardial ischemia group(39 cases) and non-myocardial ischemia group(45 cases). According to the DE value, whether there is abnormal left ventricular diastolic function was judged, and the patients were divided into left ventricular diastolic dysfunction group and normal left ventricular diastolic function group.Based on CCTA data, coronary flow reserve fraction(FFR), DE and ascending aortic elastic coefficient of pressure-strain(Ep) were measured and calculated. The correlation between DE and Ep was assessed. The relationship between DE and myocardial ischemia was analyzed. Results: There were negative correlations between DE and Ep in myocardial ischemia and non-myocardial ischemia group(r＝-0.736, -0.431, P<0.05).DE was an independent risk factor of the Ep of ascending aorta(β＝-0.420, t＝-5.002, P＜0.05).The risk of functional myocardial ischemia in the left ventricular diastolic dysfunction group was 3.188 times of that in the non left ventricular diastolic dysfunction group. Conclusion: DE of patients with essential hypertension is closely related to the elasticity of ascending aorta and myocardial ischemia. DE can provide an effective reference for early prediction of ascending aortic elasticity decline and functional myocardial ischemia in patients with essential hypertension.

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