The value of echocardiography in the early diagnosis of hypertensive heart disease in the elderly
超声心动图在老年高血压性心脏病早期诊断中的价值

摘要

目的 探讨老年高血压患者早期心脏结构与功能变化的超声心动图特征，评估其在高血压性心脏病（HHD）亚临床阶段的诊断价值。方法 选取原发性高血压老年患者31例为病例组，同期年龄匹配健康老年志愿者31例为对照组，均行标准化超声心动图检查，测量心脏腔室大小、室壁厚度、左心室质量指数（LVMI）、左心室射血分数（LVEF）、舒张功能指标（E/A、E/e’、LAVI），采用斑点追踪超声心动图（STE）测定左心室整体纵向应变（GLS），组间行统计学分析。结果 病例组LVMI显著高于对照组（105.3±22.2 vs 81.6±14.8 g/m2，p<0.001），部分患者符合左心室肥厚（LVH）诊断；E/A比值降低、E/e’与LAVI升高（均p<0.001）；GLS绝对值显著减低（-15.3%±1.8% vs -18.7%±1.6%，p<0.001），LVEF组间差异有统计学意义（p<0.001）但均在正常范围。结论 超声心动图联合常规参数与斑点追踪技术可有效识别老年高血压患者亚临床心脏结构重构与功能异常，包括左心室肥厚、舒张功能不全及隐匿性收缩功能受损，可为老年HHD早期筛查、风险评估提供无创、可重复的影像学依据，对优化临床干预、延缓疾病进展具有潜在价值，尚需前瞻性随访研究进一步验证其对预后的影响。

Abstract

Objective To investigate the echocardiographic features of early changes in cardiac structure and function in elderly patients with hypertension, and to evaluate the clinical application efficacy of this technique in identifying the subclinical stage of hypertensive heart disease (HHD).
Methods A total of 31 elderly patients diagnosed with essential hypertension were selected as the case group, and 31 age-matched elderly healthy volunteers were enrolled as the control group. All subjects underwent comprehensive standardized echocardiography, including cardiac chamber size, ventricular wall thickness, left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), diastolic function parameters (E/A, E/e’, LAVI), and left ventricular global longitudinal strain (GLS) measured by speckle tracking echocardiography (STE). Statistical analysis was used for comparison between groups.
Results LVMI in the case group was significantly higher than that in the control group (105.3±22.2 vs 81.6±14.8 g/m², p<0.001), and some patients met the criteria of left ventricular hypertrophy (LVH). E/A ratio was decreased, E/e’ and LAVI were increased (all p<0.001). The absolute value of GLS was significantly lower (-15.3%±1.8% vs -18.7%±1.6%, p<0.001). LVEF was statistically different between groups (p<0.001) but within normal range.
Conclusion   Echocardiography combined with conventional parameters and speckle tracking imaging can effectively identify subclinical cardiac structural remodeling and dysfunction in elderly hypertensive patients, including LVH, diastolic dysfunction and subclinical systolic impairment. It provides a non-invasive and reproducible imaging basis for early screening and risk assessment of elderly HHD. It has potential value for optimizing clinical intervention and delaying disease progression, and its impact on prognosis needs to be verified by prospective follow-up studies.