Gregor P, Widimský P, Kohout P, Sochor K, Bufka V, Cervenka V, Vísek V
Vnitr Lek. 1989 Jul;35(7):632-8.
The aim of the work was a more detailed characteristic of patients with hypertrophic cardiomyopathy who are threatened by an increased risk of serious disorders of the cardiac rhythm and thus probably also by sudden death. The authors analyzed a group of 64 patients subjected to 24-hour monitoring of the ECG by the Holter system. The patients were subjected to echocardiographic examination and the distribution of the myocardial hypertrophy was described in detail, incl. its extent in per cent of the affected myocardium, the mean thickness of the myocardium (arithmetic mean of the thickness of the left ventricular musculature and septum divided into 10 areas) and the maximum thickness of the heart muscle. The authors found a significantly higher incidence of serious ventricular arrhythmias in patients with an extensive area of the hypertrophy and a greater thickness of the hypertrophic myocardium. In subjects with a positive history of syncopes there was a high incidence of serious supraventricular and ventricular disorders as well as ventricular disorders of the cardiac rhythm. No relationship was found between the incidence of arrhythmias and the presence or size of obstruction. Patients with extensive hypertrophy (i.e. an extensive area of hypertrophy and thickness of the myocardium) and patients with a history of syncopes form thus as regards life-threatening arrhythmias a risk group which after diagnosis should be without delay examined by the Holter system and then treated by medicamentous therapy.
这项工作的目的是更详细地描述肥厚型心肌病患者的特征，这些患者面临心律严重紊乱风险增加，因此可能也面临猝死风险。作者分析了一组64例接受动态心电图（Holter）系统24小时心电图监测的患者。对患者进行了超声心动图检查，并详细描述了心肌肥厚的分布情况，包括其在受影响心肌中所占的百分比范围、心肌的平均厚度（将左心室肌肉组织和室间隔厚度分为10个区域后的算术平均值）以及心肌的最大厚度。作者发现，肥厚面积广泛且肥厚心肌厚度更大的患者发生严重室性心律失常的发生率显著更高。有晕厥阳性病史的患者发生严重室上性和室性紊乱以及室性心律失常的发生率很高。未发现心律失常的发生率与梗阻的存在或大小之间存在关联。因此，就危及生命的心律失常而言，肥厚广泛（即肥厚面积和心肌厚度）的患者以及有晕厥病史的患者构成一个风险组，诊断后应立即通过Holter系统进行检查，然后进行药物治疗。
