伴左室肥厚高血压病患者发生室性心律失常临床意义的探讨

对１２９例高血压病患者进行２４小时动态心电图监测，分析室性心律失常的发生。结果表明：伴左室肥厚高血压组（ｎ＝４８）复杂室性心律失常（按Ｌｏｗｎ分级≥ＩＩＩ级）的发生率显著高于无左室肥厚的高血压组（ｎ＝８１），７０．８％ＶＳ１３．６％，Ｐ＜０．００５；复杂室性心律失常昼夜变化以晨６时至正午１２时发生率较高。提示高血压病左室肥厚存在复杂室性心律失常易发性及致心律失常源的基础。积极逆转左室肥厚、改善心肌缺血及抗室性心律失常的治疗是有意义的。     

伴左室肥厚高血压病患者发生室性心律失常临床意义的探讨

对１２９例高血压病患者进行了２４小时动态心电图监测，分析室性心律失常的发生，结果表明：伴左室肥厚高血压组复杂室性心律失常的发生率显著高于无左室肥厚的高血压组（ｎ＝８１），７０．８％ＶＳ１３．６％，Ｐ＜０．００５；复杂室性心律失常昼夜变化以晨６时至下午１２时发生率较高。     

左室重量指数与复杂性室性心律失常

目的探讨左室重量指数预测复杂性室性心律失常的临床价值。方法对１１６例轻、中度高血压病人行超声心动图和动态心电图监测。４０例健康人作对照组。结果复杂性室性心律失常发生率在左室重量指数法和左室实测值法左室肥厚组分别为３６．９％，１３．９％，二者差异显著（Ｐ＜０．０１）。结论左室重量指数法左室肥厚对预测复杂室性心律失常有重要价值。     

血管紧张素转换酶基因多态性与高血压病合并左室肥厚相关性研究

目的：探讨血管紧张素转换酶（ＡＣＥ）基因插入／（Ｉ／Ｄ）多态性与原发性高血压合并左室肥厚的关系。方法：应用聚合酶链反应（ＰＣＲ）方法检测了７７ 例正常人,８０例无左室肥厚的高血压病病人,７４ 例高血压病合并左室肥厚患者的ＡＣＥＩ／Ｄ基因多态性。结果：高血压病合并左室肥厚组Ｄ等位基因频率为５１．６％ ,显著高于正常对照组（３５．６％ ,Ｐ＜ ０．０１）,及高血压无左室肥厚组（３９．３％ ,Ｐ＜ ０．０５）。结论：ＡＣＥ基因Ｄ等位基因型可能是中国高血压病患者左室肥厚的易感因素之一     

高血压病左室肥厚及舒张功能不全患者血浆NT-proBNP的变化

目的：观察高血压病左室肥厚及舒张性心功能不全患者血浆N末端脑利钠肽前体（NT-proBNP）含量变化。方法：利用酶联免疫法,对经多普勒超声心动图检查证实的68例高血压病伴左室肥厚及舒张功能不全患者及66例高血压病无左室肥厚患者的血浆NT—proBNP浓度进行测定。结果：高血压病伴左室肥厚及舒张功能不全患者组的血浆NT—proBNP浓度明显高于高血压非左室肥厚组[（308．35±74．04）pg／ml：（211．50±73．58）pg／ml,P〈0．01]。NT—proBNP与左室质量指数（LVMI）呈正相关（r=0．863,P〈0．001）,与E／A呈负相关（r=-0．758,P〈0．001）。结论：高血压病伴左室肥厚及舒张功能不全患者的血浆NT—proBNP浓度明显升高,且与应用超声心动图技术评价的高血压伴左室肥厚及舒张功能不全有较好的相关性。     

肥厚性心肌病和高血压病左室肥厚患者QT离散度的对比观察

目的：对比观察原发性肥厚性心肌病与高血压病左室肥厚患者的QT离散度。方法：以体表心电图描测15例肥厚性心肌病及42例高血压病左室肥厚患者的QT离散度（QTd）和经校正的QTd（QTCd），并与高血压无左室肥厚者及正常对照组进行比较。结果：（1）两组心室肥厚患者的QTd和QTcd均明显高于高血压元左室肥厚者及正常对照组（P＜0.01）；（2）两组心室肥厚者间以上诸指标无明显统计学差异；（3）QTd＞60ms的患者中，两组心室肥厚患者的复杂室性心律失常（≥LownⅢ级）发生率间无明显差异，但均高于高血压病无左室肥厚者。结论：无论是原发性或继发性左室肥厚均与QT离散度的增加相关，并可能为复杂室性心律失常潜在病理基础之一。     

单纯收缩期高血压患者左心室肥厚与室性心律失常的关系

目的探讨单纯收缩期高血压的病人左室肥厚与心律失常的关系。方法采用２４ｈ动态心电图和彩色多普勒超声观察患者左室肥厚及心律失常的发生情况，并观察单纯收缩期高血压与舒张期高血压左室结构改变。结果左室肥厚组室性心律失常发生率明显高于非左室肥厚组（Ｐ＞０．０１），单纯收缩期高血压组左室肥厚高于舒张期高血压组。结论左室肥厚可使室性心律失常发生率增加，收缩压增高较舒张压增高更易导致左室肥厚。     

高血压病孤立性室间隔肥厚患者心律失常分析

应用２４ｈ动态心电图以每小时房性早搏数（ＰＡＣ／ｈ）和室性早搏数（ＶＰＣ／ｈ）及复杂性室性心律失常发生率作为指标，对２２例高血压病孤立性室间隔肥厚患者、２０例高血压病向心型肥厚患者、２４例高血压病无左室肥厚患者及２０例正常对照者进行检测，结果发现，高血压病孤立性室间隔肥厚组与向心型肥厚组ＶＰＣ／ｈ及复杂性室性心律失常发生率较正常对照组和高血压病无左室肥厚组明显增加（Ｐ＜０．０５～０．０１）；而ＰＡＣ／ｈ的增加仅见于高血压病孤立性室间隔肥厚组（Ｐ＜０．０１）。表明：高血压病孤立性室间隔肥厚与向心型肥厚患者的室性心律失常和复杂性室性心律失常发生率均增高，前者房性心律失常的发生率也增高。     

冠状动脉血流储备与高血压左室肥厚患者室性心律失常的关系

对２２例正常人（Ａ组）、３０例高血压无左室肥大（ＬＶＨ）的病人（Ｂ组）及４０例高血压伴ＬＶＨ的病人（Ｃ组）的冠状动脉血流储备（ＣＦＲ）用经食道多普勒超声的方法进行了检查，以研究室性心律失常的发生与高血压伴ＬＶＨ及ＣＦＲ的可能关系。研究发现，与Ｂ组病人相比，Ｃ组病人ＣＦＲ显著降低，室性心律失常及复杂室性心律失常的发生率显著增高（分别为９０％，６０％比３０％，１０％，Ｐ＜０．０１）；Ｃ组病人中有ＣＦＲ降低者室性心律失常及复杂室性心律失常的发生率最高（９６．８％及６７．７％）．Ｃ组病人中无ＣＦＲ降低者，其室性心律失常及复杂室性心律失常之发生率与高血压无ＬＶＨ但有ＣＦＲ降低者相似（分别为６６．７％，２２．２％及６０％，２０％）。研究结果提示，在高血压病人ＬＶＨ及ＣＦＲ降低是室性心律失常发生的两个相加作用的危险因素。     

高血压左室肥厚与外周血淋巴细胞β受体密度的关系

目的观察高血压左室肥厚与外周血淋巴细胞β受体密度的关系。方法４１例高血压患者和２３例正常人进行超声心动图检查，并采用放射配体结合法测定外周血β受体密度。结果高血压左室肥厚组（ｎ＝２１）βｍａｘ高于正常对照组，高血压无左室肥厚组（ｎ＝２０）βｍａｘ低于正常对照组。高血压左室肥厚组βｍａｘ与左室肌重指数呈正相关（ｒ＝０．７６５，Ｐ＜０．０１）。结论在高血压肥厚发展期，外周血淋巴细胞β受体密度降低，心室肥厚一旦形成，淋巴细胞β受体密度反而增高。     

老年高血压左室肥厚患者的室性心律失常与心肌缺血

目的　了解老年原发性高血压左室肥厚患者的室性心律失常、心肌缺血的特点及两者的关系。方法　 90例老年 (≥ 6 0岁 )高血压患者经超声心动图测定左室质量指数 (LVMI) ,分为左室肥厚 (A组 )和非左室肥厚 (B组 )。经2 4h动态心电图测定 2 4h室性早搏总数 (VPCs)、Lown’s分级、ST段压低程度、持续时间及 2 4h发作次数。结果　A组室性心律失常的发生率明显增加 (P <0 .0 5 ) ,室性早搏 :75 %比 5 4% ,Lown’s 3～ 4级 :2 6 %比 4%。A组发作性ST段压低的发生率高 ,缺血持续时间长 (5 0 %比 15 % ,P <0 .0 5 )。所有缺血发作均为无症状性。室性心律失常与心肌缺血的昼夜节律变化基本相同。结论　无冠心病临床证据的老年原发性高血压左室肥厚患者的室性心律失常及心肌缺血的发生率增加 ,两者的昼夜节律变化基本相同     

Ventricular arrhythmias in hypertensive left ventricular hypertrophy. Relationship to coronary artery disease, left ventricular dysfunction, and myocardial fibrosis

Ventricular arrhythmias occur with increased frequency in hypertensive patients with left ventricular hypertrophy (LVH). The relationships, however, between ventricular arrhythmias and coexistent coronary artery disease, left ventricular dysfunction and left ventricular fibrosis have not been examined in hypertensive LVH. We carried out coronary arteriography on fifteen hypertensive patients with LVH and nonsustained ventricular tachycardia (greater than or equal to 3 consecutive ventricular complexes) of whom nine (60%) were free of significant (greater than 50% stenosis) coronary disease. To identify other possible correlates of left ventricular arrhythmias, 28 patients with LVH, comprising 17 with ventricular tachycardia and 11 without ventricular arrhythmias, underwent quantitative assessment of left ventricular function (angiographic ejection fraction), left ventricular mass (echocardiography), and left ventricular fibrosis (endomyocardial biopsy). Ejection fraction was not significantly different between the two groups (53 +/- 8% v 62 +/- 2%, P = NS). However, left ventricular mass was significantly greater (442 +/- 28 g v 339 +/- 34 g, P less than .05) and percentage fibrosis significantly higher (19 +/- 4% v 3 +/- 1%, P less than .001) in those patients with ventricular tachycardia. Thus ventricular arrhythmias in hypertensive patients with LVH cannot be entirely attributed to coexistent coronary disease, nor to left ventricular dysfunction, but are related to the degree of cardiac hypertrophy and subendocardial fibrosis.     

Ventricular ectopic activity in physically trained hypertensive subjects.

Exercise training is currently recommended in the management of mild hypertension, but the relationship between training and ventricular arrhythmias has never been investigated in hypertensive subjects. Forty hypertensive sportsmen were studied by means of 24-h ECG Holter monitoring and the results were compared with those obtained in 40 sedentary hypertensives, 40 normotensive sportsmen and 40 normotensive sedentary subjects. Among the hypertensive sportsmen 82.5% exhibited at least one ventricular extrasystole and 32.5% complex forms of ectopy, a prevalence higher than that observed in the sedentary hypertensives (50% and 17.5%; P = 0.002). In the normotensive sportsmen the prevalence of ventricular arrhythmias (62.5% and 22.5%) was lower than that in the hypertensive sportsmen, but the difference was not statistically significant. During a training session the prevalence of ventricular ectopy was similar in the two groups of trained individuals. Among the hypertensive sportsmen no correlation was found between the severity of ventricular arrhythmias and the degree of left ventricular hypertrophy and performance. The results of the present study suggest that exercise training may enhance left ventricular vulnerability in hypertensive subjects. Whether subjects who manifest complex ventricular arrhythmias should continue to train remains a matter for individual judgement.     

Ventricular arrhythmias in aortic valve disease: a further marker of impaired left ventricular function.

One hundred and twenty stable patients with pure and severe aortic valve disease and without coronary lesions (aortic stenosis, 43 patients; aortic regurgitation, 45 patients; combined aortic stenosis and regurgitation, 32 patients) who had been submitted to haemodynamic studies were prospectively studied with standard electrocardiograms, M-mode echocardiograms, and 24-hour ambulatory electrocardiography (Holter recording). The frequency and complexity of ventricular arrhythmias were related to clinical parameters such as functional class, type of lesion and presence of syncope, and to parameters of left ventricular hypertrophy and function. Ventricular arrhythmias were present in 92% of patients. A high number of ventricular premature beats was directly correlated with parameters of complexity of the arrhythmia. A significant relation was found between electrocardiographic left ventricular hypertrophy and Ryan class (P less than 0.05), and an inverse relation between maximal number of ventricular premature beats in any hour and left ventricular ejection fraction (P less than 0.05). The group of patients with aortic regurgitation showed a higher total number of ventricular premature beats per 24 hours (P less than 0.001), a higher maximal number of these in any hour (P less than 0.01), a higher number of patients with pairs (P less than 0.001), and a higher number of patients in Ryan classes 3, 4A, 4B (P less than 0.01). This study shows a high incidence of ventricular arrhythmias in aortic valve disease, and especially in aortic regurgitation, with a significant relation between left ventricular hypertrophy and function, and number and complexity of arrhythmias.     

In which type of hypertension should ventricular hyperexcitability be suspected?]

The aim of the present study was to determine when a search for ventricular arrhythmias, by ambulatory electrocardiographic monitoring, is necessary in hypertensive patients. An electrocardiogram, an echocardiogram and a 24 hour Holter monitoring were recorded in 88 patients with essential hypertension. According to the results of electrocardiogram patients were subdivided into 4 groups: normal electrocardiogram, isolated left auricular hypertrophy (LAH), isolated left ventricular hypertrophy (LVH) and major ST-T wave changes. According to the degree of septal thickness (ST), patients were classed in 4 groups. [table; see text] For hypertensive patients with normal electrocardiogram, Holter monitoring is not necessary; in fact practically no complex arrhythmias is found in this group. On the contrary, for hypertensive subjects with ST-T waves changes, this investigation seems very interesting, nearly 75% of them present high-grade ventricular arrhythmias. For the patients with electrocardiographic isolated LAH or LVH, the realisation of an echocardiography permits to separate the subjects with mild LVH (ST less than 12 mm) where Holter monitoring is not necessary (81% Lown O-I) and the patients with mean or severe LVH (ST greater than or equal to 12 mm) where this investigation seems very interesting, nearly 65% of them present high-grade ventricular arrhythmias.     

老年人高血压左室肥厚与心律失常关系的研究

目的探讨老年人高血压左室肥厚(LVH)与心律失常的关系。方法对178例老年高血压患者进行超声心动图及Holter检查,比较有LVH及无LVH两组各类心律失常的发生情况。结果178例老年高血压患者并发LVH81例(45·5%),LVH组各种心律失常的发生率与非LVH组比较,差别均有显著性意义(P<0·01),LVH组复杂性室性心律失常(CVA)为39例(48·1%),显著高于无LVH组的17·5%(17例)(P<0·01)。结论老年人高血压LVH与心律失常的发生有密切关系,且与CVA成正相关。     

高血压病患者心脏结构改变与心律失常的关系

分析162例高血压病患者心脏结构改变与心律失常的关系。发现高血压病患者房性心律失常多于室性心律失常（分别为79％和58％），且早期即出现，其发生率与左房大小有关。室性心律失常与心室肥厚及心肌缺血密切相关。左房增大的发生率显著高于左室肥厚的发生率。老年高血压病患者复杂心律失常的发生率、左房增大及左室肥厚的发生率均显著高于非老年高血压病患者。     

高血压左室肥大对冠状动脉基础血流和储备功能影响的探讨

目的 探讨高血压及左室肥大对冠状动脉基础血流和储备功能的影响。方法 通过多平面食道多普勒超声分别测定左冠状动脉主干静息状态下和静脉注射潘生丁后舒张期峰值血流速度(PDV)和平均血液速度(MDV),计算静脉注射潘生丁后与静息状态下上述测值之比值D/R,比较高血压左室肥大组(C组)与单纯高血压组(B组)及正常组(A组)各测算值。结果 D/R值C组和B组均显著低于A组(P<0.05～0.01),其中,静脉注射潘生丁后C组PDV和MDV值显著低于B组和A组(P<0.05～0.01),后二组之间接近,而静息状态下B组PDV和MDV值显著高于A组和C组(P<0.05～0.01)。结论 高血压左室肥大患者冠状动脉基础流速及储备功能均下降。