Mammarella A, Paradiso M, Basili S, De Matteis A, Cardarello C M, Di Franco M, Donnarumma L, Labbadia G, Paoletti V
Department of Medical Therapy, University La Sapienza, Rome, Italy.
Adv Ther. 2000 Sep-Oct;17(5):222-9. doi: 10.1007/BF02853161.
In the elderly, systemic hypertension is the main risk factor for cardiovascular diseases. Left ventricular hypertrophy, the most common adaptation to chronic pressure overload, has been recognized as an independent risk factor for an increased incidence of sudden death and arrhythmic disturbances. This study compared the prevalence of serious ventricular arrhythmias in elderly individuals with uncomplicated hypertension and in normotensive age-matched controls, using left ventricular mass index (LVMI) to differentiate patterns of anatomic adaptation to systolic, diastolic, or systolic-diastolic hypertension. The study enrolled 378 consecutive untreated elderly subjects (> or = 65 years of age), without clinical evidence of heart failure; 203 were hypertensive and 175 were normotensive. Each participant underwent standard 12-lead electrocardiography, M-mode and B-mode echocardiography, and 24-hour ambulatory electrocardiographic monitoring. Serious, statistically significant arrhythmias (Lown classes > or = 3) were present in 6.8% of normal subjects versus 17.1% of individuals with systolic, 31.5% of those with diastolic, and 20.4% of participants with systolic-diastolic hypertension. Arrhythmias did not differ in terms of left ventricular morphologic patterns or LVMI or between subgroups of hypertensive patients. Our data support the hypothesis that the pathogenesis of arrhythmias is related not to the electrophysiologic derangement of hypertrophied muscle but, rather, to the effects of hypertension on the cardiac structure. Cardiac fibrosis, one of the deleterious events accompanying hypertension, may be the main substrate for ventricular arrhythmias.
在老年人中，系统性高血压是心血管疾病的主要危险因素。左心室肥厚是对慢性压力超负荷最常见的适应性反应，已被公认为是猝死和心律失常发生率增加的独立危险因素。本研究比较了无并发症高血压老年个体和年龄匹配的血压正常对照者中严重室性心律失常的患病率，使用左心室质量指数（LVMI）来区分对收缩期、舒张期或收缩 - 舒张期高血压的解剖学适应模式。该研究纳入了378名连续的未经治疗的老年受试者（≥65岁），无心力衰竭的临床证据；其中203名是高血压患者，175名血压正常。每位参与者均接受了标准12导联心电图、M型和B型超声心动图以及24小时动态心电图监测。严重的、具有统计学意义的心律失常（洛恩分级≥3级）在正常受试者中占6.8%，在收缩期高血压患者中占17.1%，舒张期高血压患者中占31.5%，收缩 - 舒张期高血压患者中占20.4%。心律失常在左心室形态模式或LVMI方面以及高血压患者亚组之间没有差异。我们的数据支持这样的假设，即心律失常的发病机制不是与肥厚心肌的电生理紊乱有关，而是与高血压对心脏结构的影响有关。心脏纤维化是伴随高血压的有害事件之一，可能是室性心律失常的主要基础。
