高血压左室肥厚患者各种心电图改变的预后价值

The Prognostic Significance of Various Electrocardiographic Changes \;in Hypertensive Patients with Left Ventricular Hypertrophy

目的：研究高血压左室肥厚病人不同心电图改变的预后价值。 方法：对１２６ 例高血压合并左室肥厚的２０ 多项心电图改变进行预后追踪１４ 年，以性别、年龄、职业、地区配对的正常高血压２７５ 人，无左室肥厚高血压患者１６３ 人做为非暴露组进行队列研究，观察各种心脑血管并发症的发生率，评价各项心电图改变的相对危险度（ Ｒ Ｒ）。 结果：高血压和高血压合并左室肥厚病人死亡的主要原因是心脑血管意外（５６．８％ ）。单纯左室高电压不是高血压患者独立的危险因子。不对称倒置 Ｔ波、左室劳损、 Ｖ１ Ｐｔｆ异常、 Ｑ Ｖ５≥２ ｍ ｍ 及多项心电图指标异常者发生心脑血管并发症的危险性明显升高，分别为正常人的３０．６７，１４．７５，１４．７３，１２．４８，和１１．２４ 倍。矫正血压和电压因素后这些心电图异常的危险性仍高，其 Ｒ Ｒ分别为６．５５，２．９９，３．１９，２．３２，和２．２６。 结论：不对称倒置 Ｔ波、左室劳损、 Ｖ１ Ｐｔｆ异常、 Ｑ Ｖ５ ≥２ ｍ ｍ

Objective:To investigate the prognostic significance of ECG changes in hypertensive patients with left ventricular hypertrophy. Methods:One hundred twenty six hypertensives with left ventricular hypertrophy (HT LVH) were followed up for 14 years . A cohort of age, sex, region and occupation matched hypertensives without LVH (HT, n= 163) and normotensives (NT, n= 275) served as controls. Correlation between 20 specific items of electrocardiographic abnormalities and cerebral cardiovascular events were studied,and the relative risks (RR) were evaluated. Results:It was showed that the major causes of death in hypertensives with ECG LVH in this study was stroke (56.8%). LVH based on voltage criteria only was not risk factor, the higher incidence of cardiovascular events was ascribed to coexisting higher level of BP usually accompanying higher ECG voltage.Electrocardiographic manifestations of asymmetric inverted T wave, ST segment depression, V 1 Ptf≤0.04 mm.sec, Q V5 ≥2mm and comprehensive abnormalities in patients with hypertension increased the risk of cardiovascular events, with the RR of 30.67, 14.75, 14.73, 12.48 and 11.24 respectively, as compared to the normotensives. After stratification of voltage and adjustment of coexisting hypertension, the risks of above abnormalities were still significant, with RR of 6.55, 2.99, 3.19, 2.32 and 2.26 respectively. Conclusion:Asymmetric inverted T wave, ST segment depression, V 1 Ptf≤0.04 mm.sec, Q V5 ≥2 mm and comprehensive abnormalities are independent risk factors for hypertensives.