老年高血压左室肥厚患者的室性心律失常与心肌缺血

The relationship between the ventricular arrhythmia and transient episodes of myocardial ischemia in the old hypertensive patients with left ventricular hypertrophy

目的 了解老年原发性高血压左室肥厚患者的室性心律失常、心肌缺血的特点及两者的关系。方法 90例老年 (≥ 6 0岁 )高血压患者经超声心动图测定左室质量指数 (LVMI) ,分为左室肥厚 (A组 )和非左室肥厚 (B组 )。经2 4h动态心电图测定 2 4h室性早搏总数 (VPCs)、Lown’s分级、ST段压低程度、持续时间及 2 4h发作次数。结果 A组室性心律失常的发生率明显增加 (P <0 .0 5 ) ,室性早搏 :75 %比 5 4% ,Lown’s 3～ 4级 :2 6 %比 4%。A组发作性ST段压低的发生率高 ,缺血持续时间长 (5 0 %比 15 % ,P <0 .0 5 )。所有缺血发作均为无症状性。室性心律失常与心肌缺血的昼夜节律变化基本相同。结论 无冠心病临床证据的老年原发性高血压左室肥厚患者的室性心律失常及心肌缺血的发生率增加 。

Objective To investigate the relationship between the ventricular arrhythmia and transient episodes of myocardial ischemia(TEMI) in the old patients(≥60 years) with hypertensive left ventricular hypertrophy.Methods Ninety old hypertensive patients were examined by UCG and Holter ECG to determine left ventricular mass index(LVMI),which was used to divide the patients into group with left ventricular hypertrophy(group A)and group without left ventricular hypertrophy(group B).Total number of ventricular premature contraction (VPCs) in 24 hours,Lown's grade and ST segment depression(duration,maximal ST segment depression and its incidence in 24 hours) were examined by 24 hour dynamic electrocardiography.Results The incidence of ventricular arrhythmia was higher in group A than in group B(P<0.05).VPC was 75% vs 54% and Lown's 3～4 grade was 26% vs 4% in group A vs group B.TEMI was more frequent and lasted longer in patients of group A than in group B.(50% vs 15%,P<0.05). All TEMI were asymptomatic.The circadian variation of ventricular arrythmia and ST segment depression were concordant.Conclusions The old patients with hypertensive LVH,but without clinical history of coronary heart disease,have high prevalence of ventricular arrhythmia and transient episodes of myocardial ischemia.The circadian variation of ventricular arrhythmia and ST segment depression are concordant.