应用三维应变斑点追踪显像（3D-STI）技术检测高血压患者左心室心肌组织应变特征，评价高血压患者左心室收缩功能的改变。

选择2013年9月至2015年1月北京军区总医院收治的原发性高血压患者79例，其中左心室正常构型（LVN）42例，左心室肥厚（LVH）37例。另取同期健康体检者30名作为健康对照组。采集所有受检者心脏实时三维全容积成像图像，分析测定左心室射血分数（LVEF）、左心室心肌质量（LVM），得出左心室心肌质量指数（LVMI）。采用3D-STI技术测定所有受检者左心室整体纵向应变（LVGLS）、左心室整体径向应变（LVGRS）、左心室整体环向应变（LVGCS）、左心室整体面积应变（LVGAS）。采用单因素方差分析比较3组受检者LVMI、LVGLS、LVGRS、LVGCS、LVGAS差异，进一步组间两两比较采用LSD-t检验。采用Pearson相关分析比较高血压患者LVGLS、LVGAS与LVMI的相关性。

健康对照组、高血压LVN组和高血压LVH组LVMI分别为88.5±10.2、102.4±13.5、128.0±17.2，高血压LVN组、高血压LVH组LVMI均高于健康对照组，高血压LVH组LVMI高于高血压LVN组，且差异均有统计学意义（t值分别为22.152、39.623、31.125，P均<0.05）。健康对照组、高血压LVN组和高血压LVH组LVGLS分别为（-22.2±5.8）%、（-17.6±5.2）%、（-13.7±4.5）%，LVGRS分别为（41.6±7.5）%、（38.8±8.6）%、（30.1±7.4）%，LVGCS分别为（-20.9±6.6）%、（-19.6±5.4）%、（-12.4±5.5）%，LVGAS分别为（-33.2±6.9）%、（-26.6±6.4）%、（-20.2±5.6）%。高血压LVN组、高血压LVH组LVGLS、LVGAS均低于健康对照组，高血压LVH组LVGLS、LVGAS均低于高血压LVN组，且差异均有统计学意义（LVGLS：t值分别为8.642、22.623、13.125，LVGAS：t值分别为12.591、30.332、21.302；P均<0.05）；高血压LVN组LVGRS、LVGCS均低于健康对照组，但差异均无统计学意义（t值分别为0.386、0.599，P均>0.05)；高血压LVH组LVGRS、LVGCS均低于健康对照组、高血压LVN组，且差异均有统计学意义（LVGRS：t值分别为16.605、9.613；LVGCS：t值分别为10.130、9.526，P均<0.05）。高血压患者LVGLS、LVGAS均随LVMI的增高而降低，呈负相关（r值分别为-0.728、-0.853，P均<0.05）。

3D-STI技术可检测高血压患者早期左心室心肌收缩功能异常。高血压患者三维应变参数随着LVH的出现明显降低。

To explore the characteristic of three-dimensional strain speckle tracking imaging (3D-STI) of left ventricular (LV) systolic function in patients with primary hypertension (HT), and to observe the value of three-dimensional strain imaging in early diagnosis of hypertension induced myocardial dysfunction.

From September 2013 to January 2015, 79 patients with primary hypertension diagnosed in Beijing Army General Hospital were divided into two groups: group left ventricular normal geometry (LVN, n=42), and group left ventricular hypertrophy (LVH, n=37). Concurrently, 30 age-matched healthy subjects were enrolled as the controls. Parameters of LV and values of left ventricle ejection fraction (LVEF) and left ventricular mass (LVM) were acquired by three-dimensional full volume echocardiography. Left ventricular mass index (LVMI) was calculated. Left ventricle global longitudinal strain (LVGLS), left ventricle global radial strain (LVGRS), left ventricle global circular strain (LVGCS), and left ventricle global area strain (LVGAS) were analyzed off line using three-dimensional strain imaging, respectively. The global strain (LVGLS, LVGRS, LVGCS and LVGAS, respectively) and mean values of all segments were acquired. All data of 3 groups were analyzed using One-Way analysis of variance, and LSD-t test was used to compare between two groups. The correlation between LVGLS and LVMI and the correlation between LVGAS and LVMI in hypertensive patients was tested by Pearson correlation analysis.

There were significant differences of LVMI among the 3 groups (88.5±10.2, 102.4±13.5 and 128.0±17.2). LVMI were significantly increased in the LVN and LVH groups compared with those in control group. LVMI in group LVH was significantly higher than that in group LVN (t=22.152, 39.623 and 31.125, all P<0. 05). The value of LVGLS, LVGRS, LCGCS and LVGAS were (-22.2±5.8)%, (-17.6±5.2)%, (-13.7±4.5)%, (41.6±7.5)%, (38.8±8.6)%, (30.1±7.4)%, (-20.9±6.6)%, (-19.6±5.4)%, (-12.4±5.5)%, (-33.2±6.9)%, (-26.6±6.4)% and (-20.2±5.6)% in group control, group LVN and group LVH, respectively. LVGLS and LVGAS were significantly decreased in the LVN and LVH group compared with those in control group, and the LVGLS and LVGAS in group LVH were significantly lower than those in group LVN (LVGLS: t=8.642, 22.623 and 13.125; LVGAS: t=12.591, 30.332 and 21.302; all P<0.05). There was no significant difference of LVGRS and LVGCS between group LVN and control group (t=0.386 and 0.599, both P>0. 05). The parameters of LVGRS and LVGCS in LVH group were lower than those in control group and LVN group (LVGRS: t=16.605 and 9.613; LVGCS: t=10.130 and 9.526; all P<0.05). Pearson correlation analysis indicated that decreased LVGLS and LVGAS in patients with hypertension were inversely linearly correlated with increasing LVMI (r=-0.728 and -0.853, both P<0. 05).

Three-dimensional STI can evaluate the early change of left ventricular systolic dysfunctions in hypertensive patients, can detect the decreases of LV myocardial three-dimensional strain with the LVH.