Vojnosanit Pregl. 2008 May;65(5):353-8. doi: 10.2298/vsp0805353d.
BACKGROUND/AIM: Left ventricular hypertrophy (LVH), apart from arterial hypertension, is a risk factor for electrophysiologic heart condition disorder and sudden cardiac death. The aim of this study was to examine a relationship between complex ventricular arrhythmias and parameters of 24-hour ambulatory blood pressure monitoring in the patients with arterial hypertension and left ventricular hypertrophy (LVH), as well as their prognostic significance during a five-year follow-up.
Ninety patients with arterial hypertension and LVH were included in this study (mean age 55.2 +/- 8.3 years). There were 35 healthy people in the control group (mean age 54.5 +/- 7.1 years). Left ventricular mass index was 171.9 +/- 32.4 g/m2 in the LVH group and 102.4 +/- 13.3 g/m2 in the control group. Clinical examination, echocardiogram, 24-hour ambulatory blood pressure monitoring and 24-hour holter monitoring were done in all of the examined persons. Ventricular arrhythmias were classified by the Lown classification.
In the LVH group there were 54 (60.0%) of the patients with > or = III Lown class. The best predictor of a Lown class were left ventricular mass index by using multivariate stepwise regression analyses (beta = 0.212; p < 0.05) and small decrease of diastolic blood pressure during the night (beta = -0.293; p < 0.01). The main predictor of bad prognosis was left ventricular mass index during a five year follow-up (beta = 0.302; p < 0.01, for stepwise regression model: F = 8.828; p < 0.01, adjusted R2 = 0.091).
Left ventricular arrhythmias are frequent in patients with lower decrease of blood pressure during the night. There was no correlation between the degree of ventricular arrhythmias and parameters from 24-hour blood pressure monitoring and a five-year prognosis in the patients with arterial hypertension and LVH. A bad five-year follow-up outcome of hypertensive disease depends on left ventricular mass index.
背景/目的：除动脉高血压外，左心室肥厚（LVH）是心脏电生理紊乱和心源性猝死的危险因素。本研究的目的是探讨动脉高血压合并左心室肥厚（LVH）患者复杂室性心律失常与24小时动态血压监测参数之间的关系，以及它们在五年随访期间的预后意义。
本研究纳入90例动脉高血压合并LVH患者（平均年龄55.2±8.3岁）。对照组有35名健康人（平均年龄54.5±7.1岁）。LVH组左心室质量指数为171.9±32.4g/m²，对照组为102.4±13.3g/m²。对所有受检者进行临床检查、超声心动图、24小时动态血压监测和24小时动态心电图监测。室性心律失常按洛恩分类法进行分类。
LVH组中有54例（60.0%）患者的洛恩分级为Ⅲ级及以上。采用多因素逐步回归分析，左心室质量指数（β=0.212；p<0.05）和夜间舒张压小幅下降（β=-0.293；p<0.01）是洛恩分级的最佳预测指标。五年随访期间不良预后的主要预测指标是左心室质量指数（β=0.302；p<0.01，逐步回归模型：F=8.828；p<0.01，调整后R²=0.091）。
夜间血压下降幅度较小的患者左心室心律失常较为常见。在动脉高血压合并LVH患者中，室性心律失常程度与24小时血压监测参数及五年预后之间无相关性。高血压疾病五年随访不良结局取决于左心室质量指数。
