Wachtell Kristian, Okin Peter M, Olsen Michael H, Dahlöf Björn, Devereux Richard B, Ibsen Hans, Kjeldsen Sverre E, Lindholm Lars H, Nieminen Markku S, Thygesen Kristian
Department of Internal Medicine, Glostrup University Hospital, Glostrup, Denmark.
Circulation. 2007 Aug 14;116(7):700-5. doi: 10.1161/CIRCULATIONAHA.106.666594. Epub 2007 Jul 30.
Sudden cardiac death (SCD) occurs more often in patients with ECG left ventricular (LV) hypertrophy. However, whether LV hypertrophy regression is associated with a reduced risk of SCD remains unclear.
The Losartan Intervention for End Point Reduction in Hypertension (LIFE) study included 9193 patients 55 to 80 years of age with essential hypertension and ECG LV hypertrophy by gender-adjusted Cornell product (CP) (RaVL+SV(3) [+6 mm in women]). QRS duration>2440 mm x ms) and/or Sokolow-Lyon voltage (SLV) (SV1+RV(5/6)>38 mm). During follow-up (mean, 4.8 years), 190 patients (2%) experienced SCD. In time-dependent Cox analyses, absence of in-treatment LV hypertrophy was associated with a decreased risk of SCD: every 1-SD-lower in-treatment CP (1050 mm x ms) was associated with a 28% lower risk of SCD (hazard ratio [HR], 0.72; 95% CI, 0.66 to 0.79) and 1-SD-lower SLV (10.5 mm) with a 26% lower risk (HR, 0.74; 95% CI, 0.65 to 0.84). After adjustment for time-varying systolic and diastolic blood pressures, treatment allocation, age, gender, baseline Framingham risk score, ECG strain, heart rate, urine albumin/creatinine ratio, smoking, diabetes, congestive heart failure, coronary heart disease, atrial fibrillation, and occurrence of myocardial infarction, atrial fibrillation, heart failure, and noncardiovascular death, both in-treatment CP and SLV remained predictive of SCD: each 1-SD-lower CP was associated with a 19% lower risk of SCD (HR, 0.81; 95% CI, 0.73 to 0.90) and 1-SD-lower SLV with an 18% lower risk (HR, 0.82; 95% CI, 0.70 to 0.98). Absence of in-treatment LV hypertrophy by both SLV and CP was associated with a 30% lower risk of SCD (HR, 0.70; 95% CI, 0.54 to 0.92).
Absence of in-treatment ECG LV hypertrophy is associated with reduced risk of SCD independently of treatment modality, blood pressure reduction, prevalent coronary heart disease, and other cardiovascular risk factors in hypertensive patients with LV hypertrophy.
心脏性猝死（SCD）在心电图显示左心室（LV）肥厚的患者中更为常见。然而，左心室肥厚的消退是否与SCD风险降低相关仍不清楚。
氯沙坦降低高血压终点事件（LIFE）研究纳入了9193例年龄在55至80岁之间、患有原发性高血压且通过性别校正的康奈尔乘积（CP）（RaVL+SV(3) [女性≥6 mm]）、QRS时限>2440 mm×ms）和/或索科洛夫-里昂电压（SLV）（SV1+RV(5/6)>38 mm）诊断为心电图左心室肥厚的患者。在随访期间（平均4.8年），190例患者（2%）发生了SCD。在时间依赖性Cox分析中，治疗期间无左心室肥厚与SCD风险降低相关：治疗期间CP每降低1个标准差（1050 mm×ms），SCD风险降低28%（风险比[HR]，0.72；95%置信区间[CI]，0.66至0.79），SLV每降低1个标准差（10.5 mm），SCD风险降低26%（HR，0.74；95% CI，0.65至0.84）。在对随时间变化的收缩压和舒张压、治疗分配、年龄、性别、基线弗雷明汉风险评分、心电图应变、心率、尿白蛋白/肌酐比值、吸烟、糖尿病、充血性心力衰竭、冠心病、心房颤动以及心肌梗死、心房颤动、心力衰竭和非心血管死亡的发生情况进行校正后，治疗期间的CP和SLV仍然是SCD的预测指标：CP每降低1个标准差，SCD风险降低19%（HR，0.81；95% CI，0.73至0.90），SLV每降低1个标准差，SCD风险降低18%（HR，0.82；95% CI，0.70至0.98）。SLV和CP均显示治疗期间无左心室肥厚与SCD风险降低30%相关（HR，0.70；95% CI，0.54至0.92）。
在患有左心室肥厚的高血压患者中，治疗期间心电图无左心室肥厚与SCD风险降低相关，且独立于治疗方式、血压降低、冠心病患病率及其他心血管危险因素。
