Galinier M, Balanescu S, Fourcade J, Dorobantu M, Boveda S, Massabuau P, Cabrol P, Dongay B, Fauvel J M, Bounhoure J P
Cardiology Department, Rangueil University Hospital, Toulouse, France.
J Hypertens. 1997 Dec;15(12 Pt 2):1779-83. doi: 10.1097/00004872-199715120-00089.
Hypertensive left ventricular hypertrophy is associated with an increased risk of arrhythmias and mortality. However, no clinical study has demonstrated a significant relationship between ventricular arrhythmias and mortality in systemic hypertension.
To evaluate the prognostic value of arrhythmogenic markers, we included, prospectively, 214 hypertensive patients aged (mean+/-SD) 59.1+/-12.8 years, without symptomatic coronary disease, myocardial infarction, systolic dysfunction or electrolyte disturbances. At inclusion, a 12-lead electrocardiogram (ECG) with QT dispersion calculation, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, echocardiography (reliable in 187 patients) and a signal-averaged ECG (125 patients) with ventricular late potentials were recorded.
At baseline, echocardiographic left ventricular hypertrophy was found in 63 patients (33.7%). Non-sustained ventricular tachycardia (Lown class IVb) was recorded in 33 patients (16.2%) and late potentials 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, nine (4.2%) died suddenly. In univariate analysis, age, Lown class IVb and a QT dispersion > 80 ms were significantly related to global, cardiac and sudden death (P < 0.01). The left ventricular mass index was related to cardiac mortality (P= 0.002). 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 (95% confidence interval 1.2-6.0) and cardiac death 3.5-fold (95% confidence interval 1.2-9.7).
In hypertensive patients the presence of non-sustained ventricular tachycardia has prognostic value.
高血压性左心室肥厚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。
为评估致心律失常标志物的预后价值，我们前瞻性纳入了214例年龄（均值±标准差）为59.1±12.8岁的高血压患者，这些患者无有症状性冠心病、心肌梗死、收缩功能障碍或电解质紊乱。纳入时，记录了一份用于计算QT离散度的12导联心电图（ECG）、一份对室性心律失常进行洛恩分类的24小时动态心电图（204例患者）、一份超声心动图（187例患者数据可靠）以及一份检测心室晚电位的信号平均心电图（125例患者）。
基线时，63例患者（33.7%）存在超声心动图左心室肥厚。33例患者（16.2%）记录到非持续性室性心动过速（洛恩IVb级），27例患者（21.6%）存在晚电位。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（4.2%）为猝死。单因素分析中，年龄、洛恩IVb级以及QT离散度>80 ms与总体死亡、心脏死亡和猝死显著相关（P<0.01）。左心室质量指数与心脏死亡率相关（P = 0.002）。多因素分析中，只有洛恩IVb级是总体死亡和心脏死亡的独立预测因素，使总体死亡风险增加2.6倍（95%置信区间1.2 - 6.0），心脏死亡风险增加3.5倍（95%置信区间1.2 - 9.7）。
在高血压患者中，非持续性室性心动过速的存在具有预后价值。
