Manolis A J, Beldekos D, Hatzissavas J, Foussas S, Cokkinos D, Bresnahan M, Gavras I, Gavras H
Tzanio Hospital, Piraeus, Greece.
Hypertension. 1997 Sep;30(3 Pt 2):730-4. doi: 10.1161/01.hyp.30.3.730.
While evaluating 45 hypertensive patients with left ventricular hypertrophy (LVH) for enrollment in a clinical research protocol, we had the opportunity to compare anatomic and functional characteristics of those with LVH and ischemia on an exercise tolerance test (ETT), but without coronary artery disease by angiography (group I, n=8), versus those with a normal ETT (group II, n=37). There were no differences in age, sex, severity, and duration of hypertension between the two groups, but group I patients were significantly more overweight and had a worse lipid profile. Blood pressure at peak ETT was higher in group I despite shorter exercise duration, although resting and ambulatory pressures were similar. Group I patients had evidence of more pronounced cardiac enlargement and LVH by both ECG and echo criteria and a characteristic pattern of more pronounced thickening at the apex, but both groups had equally good systolic function and similar degrees of mild diastolic dysfunction. Analysis of 24-hour ambulatory ECG showed a significantly greater propensity to ventricular arrhythmias in group I, as shown by the presence of late potentials in 4 patients, the presence of couplets in 3, runs of ventricular tachycardia in 2 (while none of group II patients had late potentials or complex arrhythmias), and an average frequency of isolated premature ventricular contractions approximately three times higher in group I than group II patients. Our data demonstrate that hypertensives with LVH associated with myocardial ischemia at stress but with normal coronary arteriograms tend to be more overweight, attain a higher systolic blood pressure at ETT despite a shorter duration, have a higher propensity for severe arrhythmias, and have an adverse lipid profile. LVH in these subjects is more pronounced by both ECG and echo criteria and is characterized by predominantly apical hypertrophy with left atrial and ventricular dilatation rather than overall LV wall thickening.
在评估45例左心室肥厚（LVH）高血压患者以纳入一项临床研究方案时，我们有机会比较了运动耐量试验（ETT）显示有LVH和心肌缺血但血管造影显示无冠状动脉疾病的患者（I组，n = 8）与ETT正常的患者（II组，n = 37）的解剖和功能特征。两组在年龄、性别、高血压严重程度和病程方面无差异，但I组患者明显超重且血脂谱更差。尽管I组患者运动持续时间较短，但ETT峰值时的血压更高，尽管静息和动态血压相似。I组患者通过心电图和超声心动图标准显示有更明显的心脏扩大和LVH，且心尖部有更明显增厚的特征性模式，但两组的收缩功能同样良好，轻度舒张功能障碍程度相似。24小时动态心电图分析显示，I组发生室性心律失常的倾向明显更高，4例患者存在晚电位，3例患者存在成对早搏，2例患者出现室性心动过速（而II组患者均无晚电位或复杂心律失常），I组孤立性室性早搏的平均频率比II组患者高约三倍。我们的数据表明，有LVH且在应激时伴有心肌缺血但冠状动脉造影正常的高血压患者往往更超重，尽管运动持续时间较短但ETT时收缩压更高，发生严重心律失常的倾向更高，且血脂谱不良。这些受试者的LVH通过心电图和超声心动图标准更为明显，其特征是主要为心尖肥厚伴左心房和心室扩张，而非整体LV壁增厚。
