超声心动图诊断高血压患者严重左心室肥厚的患病率及特征分析
Prevalence and Characterisation of Severe Left Ventricular Hypertrophy Diagnosed by Echocardiography in Hypertensive Patients.
作者信息
Apitz Anett, Socrates Thenral, Burkard Thilo, Mayr Michael, Vischer Annina S
机构信息
Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland.
Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland.
出版信息
J Clin Med. 2022 Dec 28;12(1):228. doi: 10.3390/jcm12010228.
BACKGROUND
Arterial hypertension (AHT) is the leading preventable cause of death worldwide. Left ventricular hypertrophy (LVH) is one of the most important prognostic markers in hypertension and a predictor for mortality. The goals of this study were to examine the prevalence of LVH detected by echocardiography in patients with AHT and to describe patients with severe LVH.
METHODS
This is a retrospective monocentric study including patients treated at a tertiary hypertension clinic. Echocardiographic data were taken from written reports from our hospital's echocardiography laboratories. We compared patients with severe LVH (septum thickness ≥ 15 mm) with patients with normal left ventricular (LV) geometry and with patients with concentric or eccentric hypertrophy regarding age, gender, comorbidities, medication, duration of hypertension, blood pressure (BP) and ECG changes at time of echocardiography.
RESULTS
Twenty-nine patients (7.3%) out of four hundred patients showed severe LVH and one hundred and eighty-nine (47.3%) a normal geometry. In comparison to patients with normal geometry, patients with severe LVH were more likely to be male, older, and with more uncontrolled BP, especially regarding asleep values, multi-drug antihypertensive treatment and comorbidities. In comparison to patients with concentric or eccentric hypertrophy, patients with severe LVH had a significantly higher diastolic BP in the 24 h mean, awake and asleep values. A positive Sokolow-Lyon index did not predict LVH. However, patients with severe LVH were more likely to have T-wave-inversions V4-V6 in at least one lead.
CONCLUSIONS
More than half of the patients with AHT have an abnormal geometry in our study (52.5%) and 7.3% a severe LVH. Patients with severe LVH have more often an uncontrolled AHT than patients with a normal LV geometry, despite more antihypertensive treatment. The Sokolow-Lyon index seems to be insufficient to detect LVH.
背景
动脉高血压（AHT）是全球可预防的首要死亡原因。左心室肥厚（LVH）是高血压最重要的预后标志物之一，也是死亡率的预测指标。本研究的目的是检查经超声心动图检测的AHT患者中LVH的患病率，并描述重度LVH患者的情况。
方法
这是一项回顾性单中心研究，纳入了在三级高血压诊所接受治疗的患者。超声心动图数据取自我院超声心动图实验室的书面报告。我们比较了重度LVH（室间隔厚度≥15mm）患者与左心室（LV）几何结构正常的患者以及同心性或偏心性肥厚患者在年龄、性别、合并症、用药情况、高血压病程、血压（BP）和超声心动图检查时的心电图变化。
结果
400例患者中有29例（7.3%）表现为重度LVH，189例（47.3%）几何结构正常。与几何结构正常的患者相比，重度LVH患者更可能为男性、年龄更大、血压控制更差，尤其是睡眠时血压值、联合多种药物的抗高血压治疗和合并症方面。与同心性或偏心性肥厚患者相比，重度LVH患者24小时平均舒张压、清醒和睡眠时的舒张压显著更高。索科洛夫-里昂指数阳性并不能预测LVH。然而，重度LVH患者至少在一个导联更可能出现V4-V6导联T波倒置。
结论
在我们的研究中，超过一半的AHT患者存在几何结构异常（52.5%），7.3%为重度LVH。尽管接受了更多的抗高血压治疗，但重度LVH患者的AHT控制不佳的情况比LV几何结构正常的患者更常见。索科洛夫-里昂指数似乎不足以检测LVH。
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