不同方法检出的高血压性左室肥厚对预测复杂性室性心律失常的探讨

本文对无并发症的轻、中度高血压病患者98例进行了研究。结果表明,Echo-LVH(质量法)检出率为55.1%,ECG-LVH检出率为22.4%。复杂性室性心律失常发生率在Echo-LVH组、WEcho-LVH组、ECG-LVH组依次为33.3%、6.8%、4.5%。因此认为,Echo检测左室质量不仅是判断LVH的可靠指标,而且对预报复杂性室性心律失常有重要意义。     

高血压病患者左室肥厚与复杂性室性心律失常关系的研究

目的 探讨高血压病患者左室肥厚与复杂性室性心律失常的关系,为临床诊断治疗提供依据.方法 选择高血压病(均符合2005年中国高血压防治指南修订版)患者共432例,依据左室肥厚及年龄,分别分为左室肥厚、非左室肥厚及年龄≥60岁、＜60岁各两组.应用彩色超声心动图[按照美国超声心动图学会(ASE)推荐的方法 测量]和24 h动态心电图进行检查.结果 合并左室肥厚组复杂性室性心律失常的发生率高达33.76%,显著高于非左室肥厚组的9.82%;在≥60岁患者中左室肥厚及复杂性心律失常的发生率高于<60岁患者(P<0.01);有左室肥厚及复杂性心律失常者常合并缺血性ST段改变.结论 高血压病患者早期积极控制血压是减少发生左室肥厚,进而预防复杂性室性心律失常的关键,从而减少心脏事件的发生.     

高血压左室肥厚及构型与室性心律失常的关系

为探讨高血压左室肥厚(LVH)及不同构型与室性心律失常的关系,对320例有或无左室肥厚(LVH)高血压患者进行超声心动图、24h动态心电图检测.结果表明:LVH为105例,检出率为32.8%.复杂性室性心律失常的发生率在有无LVH组间有显著性差异(P<0.05),LVH程度与复杂性室性心律失常级别有密切的关系(r=0.57,p<0.05),LVH不同构型之间复杂性室性心律失常的发生率存在显著差异(p<0.05),不对称性LVH发生率较高.因此,对于肥厚程度较重、不对称LVH的高血压患者要给予高度重视.     

左室肥厚与室性心律失常关系探讨

探讨左室肥厚与室性心律失常发生的关系。采用心脏超声检查及 2 4h动态心电图监测对 10 5例患者作左室肥厚及室性心律失常监测分析。结果 :左室肥厚组 (n =5 5 )室性心律失常发生较非肥厚组 (n =5 0 )明显增多 ( 67.3 %vs 2 8.0 %,P <0 .0 1)。结论 :左室肥厚与室性心律失常的发生关系密切     

高血压左室肥厚的室性心律失常与QT间期离散度的关系

目的 探讨高血压左室肥厚（ＬＶＨ）与非左室肥厚（ＮＬＶＨ）患者的室性心律失常与ＱＴｃｄ的关系。方法 对１００例有或无左室肥厚高血压患者行ＱＴｃｄ与２４小时动态心电图监测,结果 ＬＶＨ组ＱＴｃｄ室性心律失常,复杂室性心律失常明显高于ＮＬＶＨ组（Ｐ〈０．０１）,并发现ＬＶＨ组有ＱＴｃｄ〉６０ｍｓ者室性心律失常检出率明显高于ＬＶＨ而ＱＴｃｄ〈６０ｍｓ者（０．０５≥Ｐ〉０．０１）。结论 高血压ＬＶＨ组ＱＴ     

降压干预使高血压病患者左室重量减轻后对室性心律失常的影响

本文用动态心电图观察了高血压病左室肥厚患者室性心律失常的发生情况及血管紧张素转换酶抑制剂卡托普利与钙通道阻滞剂硝苯地平(硝苯吡啶)对血浆儿茶酚胺活性、红细胞内离子(K~ 、Na~ 、Ca~(2 )、Mg~(2 ))含量、左室重量与厚度及室性心律失常的影响。结果表明,卡托普利及硝苯地平均能显著减轻高血压病左室肥厚患者左室重量与厚度,纠正细胞内离子代谢失衡,在逆转心肌肥厚的同时,显著减低了高血压病左室肥厚患者室性心律失常的发生。卡托普利可显著减低血浆儿茶酚胺活性,硝苯地平则使血浆儿茶酚胺活性升高。     

原发性高血压患者左室肥厚与室性心律失常的关系

近年来 ,原发性高血压 (EH)左室肥厚并发室性心律失常日益受到人们的重视。我们观察了 1 1 0例 EH患者 2 4 h动态心电图 ,对比分析左室肥厚对EH患者室性心律失常发生的临床意义 ,现报告如下。1　对象与方法1 .1 　 对象收集我院门诊部 1 994年至今 1 1 0例 EH患者的临床资料。 EH的诊断和左室肥厚的超声心动图诊断符合 1 993年 WHO标准。其中男 83例 ,女 2 7例 ,年龄 38～ 82 (58± 3.5)岁。全部患者经详细询问病史、体检、肝肾功能、X线胸片、超声心动图等检查 ,排除继发性高血压及其他器质性心脏病。将患者分为两组 :左室肥厚组 46…     

室性心律失常与原发性高血压相关性探讨

本文以24h动态心电图仪分析60例高血压(EH)患者,60例正常人作为对照组(A组),以探讨EH并发室性心律失常(VR)的相关因素。结果显示,VR检出率EH组(B组)与A组分别为66.6％与13.3％(P<0.001)。EH组左室肥厚(LAH)(B1组)与无LVH(B2组)VR检出率分别为100％与58.3％(P<0.001)。高血压Ⅰ～Ⅲ期VR检出率分别为39.4％、100％、100％。结果表明B组VR明显高于B2组者和A组。提示EH患者VR的发生率与LVH病变程度密切相关。     

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。     

QT离散度与高血压病左室肥厚患者室性心律失常的关系

检测130例有或无左室肥厚（LVH）高血压病患者的QT离散度（QTd）和24h动态心电图。结果发现：室性心律失常（VA）检出率为54．62％；VA、复杂VA及室透（VT）患者QTd显著高于无VA者（分别P＜0．05、＜0．01、＜0．01）；LVH者QTd显著高于无LVH者（P＜0．05）；并发现LVH又QTd＜60ms者VA、复杂VA及VT检出率均显著高于LVH但QTd＜60ms者（均P＜0．01）。提示QTd对于预测高血压病LVH者发生VA可能具有一定的参考价值。     

老年高血压患者心律失常特点及其与左室肥厚的关系

分析原发性高血压病226例（老年组139例，非老年组87例）和80例健康老年人（对照组）24h动态心电图检测的心律失常。结果示总房性和室性心律失常发生率在高血压老年组为97％和77％，非老年高血压组为85％和53％，对照组为89％和59％；其中阵发房速、房颤和Lown's分级≥3的室性心律失常在高血压老年组达47％和40％，非老年组21％和22％，对照组30％和11％（P＜0．05～0．001）。在高血压老年组中62例伴左室肥厚（LVH），其总室住心律失常发生率和town's分级≥3者达92％和57％，均高于无LVH者的65％和27％（P＜0．001）。提示其发生与LVH密切相关。     

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。     

Multivariate Analysis of Left Ventricular Mass Determinants in Adults

Echocardiographic left ventricular mass (LVM) estimates are strong predictors of subsequent mortality and cardiovascular events. It is known that blood pressure (BP), weight (WT), and age are significantly correlated with LVM. We hypothesized that stroke volume (SV) measured by Doppler echocardiography would also be correlated with LVM. Two hundred and thirteen patients referred for routine echocardiography had determination of LVM, cuff BP, and Doppler SV. Those with localized LV disease, valvular disease, or cor pulmonale were excluded. In both men and women, systolic BP (SBP) was more closely correlated with LVM than was diastolic blood pressure or mean arterial pressure, and SV was more closely correlated with LVM than cardiac output or cardiac index. Stepwise regression, followed by multiple regression showed that four variables (WT, SV, SBP, and AGE) explained 32.3% of the variability in LVM in men and 48.5% of the variability in LVM in women. WT and SV were significant determinants of LVM in both men and women. Age was also significant in men and SBP was also significant in women. For both men and women, SV was more significantly correlated with LVM than was SBP. The changes in LVM associated with 1 SD increments of SV and SBP, respectively, were 8 and 5 g for men and 13 and 11 g for women. We conclude that men and women have different patterns of variables influencing LVM. Doppler echocardiographic SV is a newly described determinant of LVM that has a greater correlation with LVM than does SBP. This study reemphasizes the importance of WT as the major determinant of LVM.     

原发性高血压左心室肥厚与心律失常的关系

目的探讨原发性高血压(EH)病人左心室肥厚(LVH)与心律失常的关系.方法采用24 h动态心电图(DCG)、超声心动图(UCG)对156例EH病人进行检查并分组分析.结果LVH组室性心律失常和复杂室性心律失常的发生率显著高于非LVH组(P＜0.01);房性心律失常的发生率显著高于室性心律失常(P＜0.01).结论左心室肥厚是导致室性心律失常的危险因素之一.     

Measurement of Wall Thickness Alone Does Not Accurately Assess the Presence of Left Ventricular Hypertrophy

Clinical echocardiographic assessment of left ventricular hypertrophy (LVH) is generally performed by measuring wall thickness alone (WT). The objective of this study was to compare the assessment of LVH using the measurement of WT to that using indexed LV mass. Hypertensive patients underwent echocardiography with the measurement of LV WT and LV mass. For each patient, the presence of LVH was assessed by both methods with WT compared to the gold standard of LV mass index. In all, 92 patients (51M/41F) were entered, and in only 55 patients (60%) were the two methods concordant. There was a tendency for WT to underestimate LVH in females (sensitivity 37%, specificity 79%) and overestimate LVH in males (sensitivity 88%, specificity 56%). The measurement of WT alone overestimates LVH in males and underestimates LVH in females and should not be used as a surrogate marker for increased LV mass.     

高血压左室肥厚与室性心律失常的研究进展

研究表明高血压左室肥厚的患者室性心律失常,尤其是复杂性室性心律失常发生率增高,目前认为主要与左室重构、心肌缺血、肥厚心肌的电生理改变、神经内分泌因子分泌异常等多种因素有关。在对高血压病的患者进行降压治疗的同时逆转左室肥厚能减少室性心律失常的发生,肾素-血管紧张素系统抑制剂因在此方面作用显著而倍受关注。     

高血压患者左室肥厚与冠脉狭窄程度的关系分析

目的　探讨高血压患者左心室肥厚 (LVH)与冠状动脉狭窄程度之间的相关关系。方法　顺序入选 10 4例住院高血压病患者 ,男 72例 ,女 32例 ,平均年龄 5 9 15± 7 6 8岁。 10 4例病人均进行冠状动脉造影 (CAG)检查 ,并常规进行空腹血糖 (GLU )、三酸甘油酯 (TG)、总胆固醇 (TC)、12导心电图 (ECG)以及超声心动图 (UCG)等检查 ,其中 5 9例病人做了活动平板运动试验 (TEST)。统计学处理采用Spearman等级相关和多元逐步回归法 ,分析LVH的程度与冠状动脉狭窄支数之间的相关关系。结果　Spearman法显示室间隔厚度 (IVST)、左室后壁厚度 (LVPWT)、左室质量指数 (LVMI)与CAG狭窄病变的支数间均有显著等级相关性 (r分别为 0 2 5 ,0 2 1和 0 2 4 ;P均 <0 0 1)。多元逐步回归分析显示 :TEST阳性、GLU、性别 (Sex)、TC、LVPWT以及LVMI与CAG呈显著相关性 (F分别为 7 4 1,8 16 ,7 36 ,6 5 5 ,5 5 5和 6 36 ;P分别为 0 0 0 2 1,0 0 0 2 8,0 0 2 77,0 0 4 0 3,0 0 0 5 7和0 0 0 98)。结论　提示高血压患者除Sex、TC、GLU、TEST结果阳性与冠脉狭窄病变间有显著相关性外 ,IVST、LVPWT以及LVMI与冠脉狭窄病变的支数间有明显的等级正相关 ,即左室壁越厚、LVMI越大者 ,冠脉狭窄累及的支数越多     

逆转高血压左心室肥厚对心肌缺血和心律失常的影响

观察 2 0例冠状动脉造影证实无明显狭窄病变的高血压左室肥厚 (LVH )者 ,经尼群地平和巯甲丙脯酸治疗 1～ 2年 ,LVH逆转后对心肌缺血和室性心律失常的影响。结果表明 ,治疗前休息或运动时心电图ST段缺血性压低的 14例中 ,有 9例(6 4% )治疗后心肌缺血消失 ;室性心律失常发生率无变化 ,但Lown氏分级程度有减轻趋势。结果提示 ,逆转高血压LVH是改善心肌缺血的一个有效的治疗途径     

高血压左室肥厚诊断的探讨

随机选择104例高血压患者（血压≥160／95mmHg）进行心电图（ECG）和超声心动图（UCG）检查。结果UCG左心室肥厚（LVH）检出率为76％，ECGLVH检出率为24％，ECGLVH患者的左心室重量指数（LVMI）显著增大，伴左心宝功能不全者的LVMI也明显增大，多元相关分析示LVMI与舒张末期左心室内径、室间隔厚度、左室后壁厚度呈显著正相关（P＜0．001）。     

Hypertensive Left Ventricular Hypertrophy: Pathophysiology, Assessment and Treatment

Otterstad JE, Smiseth O, Kjeldsen SE. Hypertensive Left Ventricular Hypertrophy: Pathophysiology, Assesment and Treatment.

Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular morbidity and mortality. LVH is associated with coronary events, and there is an association between cerebrovascular disease and increased left ventricular mass (LVM). Experimental studies have elucidated the importance of non-myocytic cells inducing increased perivascular and interstitial fibrosis along with thickening of the media of intramyocardial coronary arteries in hypertensive LVH. M-mode echocardiography is the most accepted standard for the diagnosis and quantification of LVH, but some controversies exist regarding the ideal methodology for serial assessment of LVM. It is still a matter of debate whether 2-dimensional echo measurements represent a more accurate method. Hopefully, both the introduction of 3-dimensional echo and new Doppler techniques can provide more accurate measurements of LVM and additional information on changes in myocardial fibrosis and stiffness. Experimental studies have shown that normalization of hypertensive myocardial and coronary artery remodelling take place with drugs like angiotensin converting enzyme (ACE)-inhibitors and calcium antagonists. Two meta-analyses suggest that ACE-inhibitors may be the most efficient drugs in reducing LVM, but a clinical correlate to this assumption is at present not available. There are some indications that regression or progression of LVH assessed by ECG and echocardiography may in fact be related to the incidence of cardiovascular events. But large-scale controlled studies of various treatment regimens are still needed to establish whether drug induced regression can improve the prognosis of hypertensive LVH independent of the antihypertensive effect.