Burke A P, Farb A, Liang Y H, Smialek J, Virmani R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Circulation. 1996 Dec 15;94(12):3138-45. doi: 10.1161/01.cir.94.12.3138.
Epidemiological studies have shown that hypertension and left ventricular hypertrophy (LVH) increase the risk of sudden cardiac death (SCD) in patients with severe coronary artery disease (CAD). However, autopsy studies comparing the morphological substrates for SCD in normotensives and hypertensives are lacking.
Heart weight and coronary plaque morphology were prospectively compared in SCD in 36 hypertensive and 63 normotensive individuals. The frequency of CAD was similar in hypertensives (69%, n = 25) and normotensives (73%, n = 46). In 71 hearts with CAD, acute coronary thrombi were present in 76% of normotensives versus 36% of hypertensives (P = .002), LVH was present in 64% of hypertensives versus 33% of normotensives (P = .01) and in 72% of hypertensives with one-vessel disease versus 17% of normotensives with one-vessel disease (P = .0005), and a healed or acute infarct without acute thrombus was present in 36% of hypertensives versus 9% of normotensives (P = .007). Heart weight was higher in all cases of plaque rupture (519 +/- 109 g) than eroded plaque (381 +/- 92 g, P = .0002). In contrast to hypertensives, normotensive hearts with severe CAD showed a stepwise increase in heart weight with one-, two-, and three-vessel disease (P = .01).
Severe CAD is present in most SCD in hypertensive and normotensive individuals, but acute thrombi are more common in normotensives. LVH is an important contributing mechanism of SCD in hypertensives, especially in cases of one-vessel disease. LVH is associated with plaque rupture and extent of disease in SCD in normotensives with severe CAD.
流行病学研究表明，高血压和左心室肥厚（LVH）会增加严重冠状动脉疾病（CAD）患者心源性猝死（SCD）的风险。然而，缺乏对正常血压者和高血压者心源性猝死形态学基础进行比较的尸检研究。
前瞻性比较了36例高血压患者和63例正常血压者心源性猝死时的心脏重量和冠状动脉斑块形态。高血压患者（69%，n = 25）和正常血压者（73%，n = 46）的CAD发生率相似。在71例患有CAD的心脏中，76%的正常血压者存在急性冠状动脉血栓，而高血压者为36%（P = .002）；64%的高血压者存在LVH，正常血压者为33%（P = .01），在单支血管病变的高血压者中72%存在LVH，单支血管病变的正常血压者中为17%（P = .0005）；36%的高血压者存在无急性血栓的陈旧性或急性梗死，正常血压者为9%（P = .007）。所有斑块破裂病例的心脏重量（519±109 g）高于糜烂斑块（381±92 g，P = .0002）。与高血压者不同，患有严重CAD的正常血压者心脏重量随单支、双支和三支血管病变呈逐步增加（P = .01）。
高血压和正常血压个体的大多数心源性猝死病例都存在严重CAD，但急性血栓在正常血压者中更常见。LVH是高血压者心源性猝死的重要促成机制，尤其是在单支血管病变的情况下。在患有严重CAD的正常血压者的心源性猝死中，LVH与斑块破裂和疾病范围相关。
