Galinier M, Balanescu S, Fourcade J, Dorobantu M, Massabuau P, Dongay B, Cabrol P, Fauvel J M, Bounhoure J P
Service de cardiologie CHU Rangueil, Toulouse.
Arch Mal Coeur Vaiss. 1997 Aug;90(8):1049-53.
Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. However, no clinical study demonstrated a significant relation between ventricular arrhythmias and mortality in systemic hypertension.
To evaluate the prognostic value of arrhythmogenic markers in systemic hypertension, we included between 1987 and 1993. 214 hypertensive patients, 59.1 +/- 12.8 years old, without symptomatic coronary disease, myocardial infarction, systolic dysfunction, electrolyte disturbances or antiarrhythmic therapy. At inclusion, an ECG, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, an echocardiography (reliable in 187 patients) with left ventricular mass index and ejection fraction calculation, a SAECG (125 patients, enrolled after 1988) with ventricular late potentials (LP) were recorded. QT interval dispersion (QTd) was calculated on 12 leads standard ECG and LVH was appreciated.
At baseline echocardiographic LVH was recorded in 63 patients (33.7%) with normal ejection fraction (75 +/- 7.4%). Non-sustained ventricular tachycardia (Lown IVb) was found in 33 pts (16.2%) and LP in 27 patients (21.6%). After a mean follow up of 42.4 +/- 26.8 months, all-cause mortality was 11.2% (24 patients); 17 patients died of cardiac causes (7.9%); of these 9 patients (4.2%) died suddenly. In univariate analysis, age, strain pattern of LVH, advanced Lown classes and abnormal QT dispersion (> 80 ms) were significantly related to global, cardiac and sudden death (p < or = 0.01). Left ventricular mass index was closely related to cardiac mortality (p = 0.002). LP failed to predict mortality. In multivariate analysis, only Lown class IVb was an independent predictor of global and cardiac mortality, increasing the risk of global death 2.6 fold [1.2-6.0] (CI 95%) and the risk of cardiac death 3.5 fold [1.2-9.7] (CI 95%).
In hypertensive patients the presence of non-sustained ventricular tachycardia on 24 h Holter has a prognostic value.
高血压性左心室肥厚（LVH）与心律失常及死亡风险增加相关。然而，尚无临床研究证实系统性高血压患者室性心律失常与死亡之间存在显著关联。
为评估系统性高血压中致心律失常标志物的预后价值，我们纳入了1987年至1993年间的214例高血压患者，年龄59.1±12.8岁，无症状性冠心病、心肌梗死、收缩功能障碍、电解质紊乱或抗心律失常治疗。纳入时，记录一份心电图、一份24小时动态心电图（204例患者）并按洛恩标准对室性心律失常进行分类、一份超声心动图（187例患者数据可靠）以计算左心室质量指数和射血分数、一份信号平均心电图（125例患者，1988年后纳入）以检测心室晚电位（LP）。在12导联标准心电图上计算QT间期离散度（QTd）并评估LVH情况。
基线时，63例患者（33.7%）经超声心动图检查发现有LVH，射血分数正常（75±7.4%）。33例患者（16.2%）发现非持续性室性心动过速（洛恩IVb级），27例患者（21.6%）发现LP。平均随访42.4±26.8个月后，全因死亡率为11.2%（24例患者）；17例患者死于心脏原因（7.9%）；其中9例患者（4.2%）猝死。单因素分析中，年龄、LVH的应变模式、较高的洛恩分级以及异常的QT离散度（>80毫秒）与全因、心脏及猝死显著相关（p≤0.01）。左心室质量指数与心脏死亡率密切相关（p = 0.002）。LP未能预测死亡率。多因素分析中，只有洛恩IVb级是全因和心脏死亡率的独立预测因素，全因死亡风险增加2.6倍[1.2 - 6.0]（95%可信区间），心脏死亡风险增加3.5倍[1.2 - 9.7]（95%可信区间）。
在高血压患者中，24小时动态心电图上出现非持续性室性心动过速具有预后价值。
