老年高血压性左室舒张功能不全对房室性心律失常的影响

Effect of abnormal left ventricular diastolic function on occurrence of atrial or ventricular arrhythmia in elderly essential hypertensive patients

目的 研究老年高血压患者左室舒张功能不全对房、室性心律失常发生及其严重程度的影响.方法 入选老年原发性高血压患者210例,均经24 h动态心电图检查判定心律失常情况,和多普勒超声心动图检查评价心脏结构和功能.根据不同左室舒张充盈类型分为正常舒张充盈型（即左室舒张功能正常组）、松弛受损型、假正常充盈型、限制性充盈型（后3型为左室舒张功能不全组）.结果 （1）共检出房性心律失常占70%,室性心律失常占49%,两组差异有统计学意义（χ2=19.975,P〈0.05） （2）左室舒张功能不全组的房、室性心律失常发生率以及复杂房、室性心律失常发生率分别为89%、63%、49%、30%,均高于左室舒张功能正常组[40%、26%、13%、7%,χ2=56.723、28.359、28.076、15.9102,P〈0.05] （3）不同左室舒张充盈类型间的房室性心律失常以及复杂房室性心律失常的发生率差异亦有统计学意义（P〈0.05）,其中以假正常充盈型和限制性充盈型的发生率最高,分别为93.6%和96.4%.结论 老年高血压患者左室舒张功能不全促进房、室性心律失常的发生,并影响其严重程度 左室舒张功能不全的假正常充盈型和限制性充盈型易发生复杂房、室性心律失常.

Objective To study the effect of abnormal left ventricular diastolic function（LVDF）on the onset and severity of atrial or ventricular arrhythmia in elderly essential hypertensive patients.Methods The 210 elderly essential hypertensive patients were enrolled in this study. Their arrhythmias were monitored by 24-hour ambulatory electrocardiogram. The essential hypertensive patients were referred for Doppler echocardiography to evaluate left ventricular function, while patients with abnormal systolic function were excluded, and then the patients were classified as normal LVDF and abnormal LVDF including, impaired relaxation, pseudonormal, and restrictivelike filling patterns. Results In 210 elderly essential hypertensive patients, 147 （70%） cases were diagnosed as atrial arrhythmia and 102 （49%） cases as ventricular arrhythmia （χ2 = 19. 975, P 〈 0.05 ）.Morbidities of atrial （89%） or complex atrial arrhythmia （49%） as well as ventricular （63%） orcomplex ventricular arrhythmia （30%） were significantly higher in abnormal LVDN group than in normal LVDN group （40%, 13%, 26% and 7%, χ2 = 56. 723 、 28. 359 、 28. 076、15. 9102 , all P〈0. 05）. The morbidities of arrhythmias were higher in hypertensive patients with pseudonormal and restrictiveike filling patterns than in other groups 93.6% and 96. 4%. Conclusions Abnormal left ventricular diastolic function affects on the onset and severity of atrial or ventricular arrhythmia in elderly essential hypertensive patients, and complex atrial or ventricular arrhythmia is easier found in hypertensive patients with pseudonormal and restrictivelike filling patterns.