Galinier M, Balanescu S, Fourcade J, Dorobantu M, Albenque J P, Massabuau P, Doazan J P, Fauvel J M, Bounhoure J P
Cardiology Department, Rangueil University Hospital, Toulouse, France.
Eur Heart J. 1997 Sep;18(9):1484-91. doi: 10.1093/oxfordjournals.eurheartj.a015476.
To evaluate the prognostic value of arrhythmogenic markers in hypertensive patients.
Two hundred and fourteen hypertensive patients without symptomatic coronary disease, systolic dysfunction, electrolyte disturbances or anti-arrhythmic therapy were included. Recordings were made of 12-lead standard ECGs with calculations of QT interval dispersion, 24 h Holter ECGs (204 patients), echocardiography (187 patients) and signal-averaged ECGs (125 patients).
echocardiographic left ventricular hypertrophy was found in 63 patients (33.7%), non-sustained ventricular tachycardia (Lown class IV b) in 33 patients (16.2%), ventricular late potentials in 27 patients (21.6%). Mortality: after a mean follow-up of 42.4 +/- 26.8 months, global mortality was 11.2% (24 patients), cardiac mortality 7.9% (17 patients), sudden death 4.2% (nine patients). Univariate analysis: predictors of global, cardiac and sudden death were age > or = 65 years, ECG strain pattern, Lown class IV b and QT interval dispersion > 80 ms (P < or = 0.01). Left ventricular mass index was closely related to cardiac mortality (P = 0.002). Multivariate analysis: only Lown class IV b was an independent predictor of global (RR 2.6, 95% CI 1.2-6.0) and cardiac mortality (RR 3.5, 95% CI 1.2-9.7).
In hypertensive patients, non-sustained ventricular tachycardia has a prognostic value.
评估致心律失常标志物在高血压患者中的预后价值。
纳入214例无冠心病症状、收缩功能障碍、电解质紊乱或抗心律失常治疗的高血压患者。记录12导联标准心电图以计算QT间期离散度，24小时动态心电图（204例患者）、超声心动图（187例患者）和信号平均心电图（125例患者）。
63例患者（33.7%）存在超声心动图左心室肥厚，33例患者（16.2%）存在非持续性室性心动过速（Lown分级IVb级），27例患者（21.6%）存在心室晚电位。死亡率：平均随访42.4±26.8个月后，总死亡率为11.2%（24例患者），心脏死亡率为7.9%（17例患者），猝死率为4.2%（9例患者）。单因素分析：总死亡、心脏死亡和猝死的预测因素为年龄≥65岁、心电图应变模式、Lown分级IVb级和QT间期离散度>80 ms（P≤0.01）。左心室质量指数与心脏死亡率密切相关（P = 0.002）。多因素分析：仅Lown分级IVb级是总死亡（RR 2.6，95%CI 1.2 - 6.0）和心脏死亡（RR 3.5，95%CI 1.2 - 9.7）的独立预测因素。
在高血压患者中，非持续性室性心动过速具有预后价值。
