Shenasa Mohammad, Shenasa Hossein
Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, 105 North Bascom Ave, Suite 204, San Jose, CA 95128, United States.
Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, 105 North Bascom Ave, Suite 204, San Jose, CA 95128, United States.
Int J Cardiol. 2017 Jun 15;237:60-63. doi: 10.1016/j.ijcard.2017.03.002. Epub 2017 Mar 3.
Hypertension (HTN) is the most common cause of hypertensive heart disease, which comprises of left ventricular hypertrophy (LVH), left atrial enlargement, diastolic dysfunction, functional mitral regurgitation and neurohormonal changes. All of these lead to significant arrhythmias such as atrial fibrillation (AF) as well as ventricular arrhythmias, and are known risk factors for sudden cardiac death (SCD). The association between LVH and SCD is well established, especially in the presence of myocardial ischemia, fibrosis and scar tissue, and AF. Inflammation, fibrosis and oxidative stress, as well as ischemia play a significant role and are the leading pathways to remodeling, arrhythmias, and SCD. Aggressive HTN control may lead, at least in part, to regression of LVH and thus lower the risk of AF and SCD. Therefore, LVH is a powerful, independent predictor of AF, ventricular arrhythmias and SCD, and is significantly underrecognized. Further investigation of the relationship and management of diastolic dysfunction, LVH and genetic factors and their association with SCD is certainly warranted.
高血压（HTN）是高血压性心脏病最常见的病因，高血压性心脏病包括左心室肥厚（LVH）、左心房扩大、舒张功能障碍、功能性二尖瓣反流和神经激素变化。所有这些都会导致严重的心律失常，如心房颤动（AF）以及室性心律失常，并且是心源性猝死（SCD）的已知危险因素。LVH与SCD之间的关联已得到充分证实，尤其是在存在心肌缺血、纤维化和瘢痕组织以及AF的情况下。炎症、纤维化、氧化应激以及缺血起着重要作用，并且是导致重塑、心律失常和SCD的主要途径。积极控制高血压至少在一定程度上可能会使LVH消退，从而降低AF和SCD的风险。因此，LVH是AF、室性心律失常和SCD的一个强大的独立预测因子，并且明显未得到充分认识。对舒张功能障碍、LVH与遗传因素之间的关系及其管理以及它们与SCD的关联进行进一步研究当然是必要的。
