Dunn F G, Pringle S D
J Hypertens. 1993 Oct;11(10):1003-10. doi: 10.1097/00004872-199310000-00002.
To evaluate the relationship between sudden cardiac death, ventricular arrhythmias and left ventricular hypertrophy in patients with hypertension.
Epidemiological studies assessing the importance of left ventricular hypertrophy as a risk factor for sudden cardiac death, studies assessing the prevalence of arrhythmias in left ventricular hypertrophy and studies assessing whether there is an electrophysiological substrate in the hypertrophied myocardium for ventricular dysrhythmias.
Current evidence indicates that left ventricular hypertrophy is a risk factor for sudden cardiac death and that ventricular arrhythmias are more prevalent in hypertensive patients with than in those without left ventricular hypertrophy. However, there is a lack of evidence that these dysrhythmias are important as an underlying mechanism for sudden cardiac death, and there is no clear evidence that the hypertrophied myocardium is, itself, an arrhythmogenic substrate for malignant ventricular dysrhythmias. One possible mechanism for sudden cardiac death is myocardial ischaemia, either as a consequence of associated coronary disease or due to left ventricular hypertrophy, but this remains unproved.
There is currently no evidence that the ventricular ectopic activity seen in patients with hypertensive left ventricular hypertrophy is a marker for sudden cardiac death. Clarification of the mechanisms involved in sudden cardiac death will help in selecting appropriate preventive and therapeutic strategies for these patients.
评估高血压患者心脏性猝死、室性心律失常与左心室肥厚之间的关系。
评估左心室肥厚作为心脏性猝死危险因素重要性的流行病学研究、评估左心室肥厚中心律失常患病率的研究以及评估肥厚心肌中是否存在室性心律失常电生理基质的研究。
现有证据表明左心室肥厚是心脏性猝死的危险因素，且高血压合并左心室肥厚患者的室性心律失常比未合并左心室肥厚患者更为普遍。然而，缺乏证据表明这些心律失常作为心脏性猝死的潜在机制具有重要意义，也没有明确证据表明肥厚心肌本身是恶性室性心律失常的致心律失常基质。心脏性猝死的一种可能机制是心肌缺血，这可能是由相关冠状动脉疾病引起，也可能是左心室肥厚所致，但这仍未得到证实。
目前没有证据表明高血压左心室肥厚患者出现的室性异位活动是心脏性猝死的标志物。明确心脏性猝死的相关机制将有助于为这些患者选择合适的预防和治疗策略。
