Résumé
Objective:To investigate the changes of intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) in different diastolic phases of hypertensive patients with different left ventricular configurations by relative pressure imaging (RPI) based on vector flow mapping (VFM), and to explore its diagnostic value for diastolic function in hypertensive patients with different left ventricular configurations.Methods:Totally 180 patients with hypertension were selected from April 2020 to March 2021 in the Outpatient Clinic of the Second Affiliated Hospital of Harbin Medical University. According to the relative wall thickness (RWT) and left ventricular mass index (LVMI), the patients were divided into normal geometry group (NG group, n=62), concentric remodeling group (CR group, n=62) and concentric hypertrophy group (CH group, n=56). Sixty-one healthy volunteers were selected as the control group. Clinical data and echocardiographic parameters were collected and the differences of each parameter among 4 groups were compared. IVPDs and IVPGs in four diastolic phases were obtained by RPI, including isovolumic relaxation (IR), rapid filling (RF), slow filling (SF) and atrial contraction (AC). The differences of IVPDs and IVPGs in each phase of diastole among 4 groups and their correlations with echocardiographic parameters were analyzed, and the diagnostic efficacy of RPI parameters in NG group patients with reduced diastolic function was analyzed by the ROC curve. Results:The absolute values of IVPDs and IVPGs were greater in all subgroups of hypertension than those of the control group at each diastole phase( P<0.001). Pairwise comparisons showed statistically significant differences of IVPDs-IR and IVPGs-IR among 4 groups( P<0.001). They were correlated with E/e′( rs=-0.615, -0.605; all P<0.001). IVPDs-IR and IVPGs-IR had good diagnostic efficacy for the decrease of diastolic function of patients in NG group, the cutoff values were <-0.705 mmHg (AUC=0.935, P<0.001) and <-0.130 mmHg/cm (AUC=0.926, P<0.001). Conclusions:RPI can precisely assess different degrees of diastolic function changes in hypertensive patients with different configurations. IVPDs-IR and IVPGs-IR can be used as potential new indicators for non-invasive early diagnosis of hypertensive patients with reduced diastolic function, which is of great significance for timely clinical intervention and treatment of reversing ventricular remodeling.